GEM EMPLOYMENT APPLICATION
GEM is an Equal Opportunity Employer dedicated to non-discrimination in employment.
PERSONAL INFORMATION:

NAME (Last. First, MI):
POSITION APPLYING FOR:
PRESENT ADDRESS:
PHONE NUMBER:
TODAY'S DATE:
E-MAIL ADDRESS:
DATE AVAILABLE:

EMPLOYMENT INFORMATION:

Position Desired:
Desired Salary:
If hired, can you provide documentation of your legal right to work in the U.S.?
YES  NO
If you are under 18 and it is required, can you furnish a work permit?
YES  NO
Are you able to meet the attendance requirements of this position?
YES  NO
Have you ever served in the U.S. Armed Forces?
YES  NO
Which Branch?
From: to 

Availability:

Sunday Monday Tuesday Wednesday Thursday Friday Saturday

EMPLOYMENT HISTORY:
List below all present and past employment starting with your most recent (or current) employer. Account for all periods of unemployment. If attaching a resume please complete information not contained in the resume.
From
To
Employer
Telephone
Starting Job Title/Final Job Title
/
Address
Supervisor
Reason for Leaving
May we Contact for Reference?
YES  NO
Rate/ Salary
Starting: Final: 
From
To
Employer
Telephone
Starting Job Title/Final Job Title
/
Address
Supervisor
Reason for Leaving
May we Contact for Reference?
YES  NO
Rate/ Salary
Starting: Final: 
From
To
Employer
Telephone
Starting Job Title/Final Job Title
/
Address
Supervisor
Reason for Leaving
May we Contact for Reference?
YES  NO
Rate/ Salary
Starting: Final: 

EDUCATIONAL BACKGROUND:

NAME AND LOCATION NUMBER OF YEARS COMPLETED MAJOR / FIELD OF STUDY DID YOU GRADUATE?
HIGH SCHOOL
COLLEGE
TRADE, BUSINESS, CORRESPONDENCE
OTHER

REFERENCES:

NAME YEARS KNOWN COMPANY / TITLE PHONE NUMBER
/
/
/
/

APPLICANT STATEMENT:
   I certify that all the information I have provided in order to apply and secure work with the employer is true, complete and correct.
   I understand that any information provided by me that is found to be false, incomplete or misrepresented in any respect, will be sufficient cause to (i) cancel further consideration of this application, or (ii) immediately discharge me from this employer’s service, whenever it is discovered.
   I expressly authorize, without reservation, the employer, its representatives, employees or agents to contact and obtain information from all references (personal and professional), employers, public agencies, licensing authorities and educational institutions and to otherwise verify the accuracy of all information provided by me in this application, resume or job interview. I hereby waive any and all rights and claims I may have regarding the employer, their agents, employees or representatives, for seeking, gathering and using such information in the employment process and all other persons, corporations or organizations for furnishing such information about me.
   I understand that the employer does not unlawfully discriminate in employment and no question on this application is used for the purpose of limiting or excusing an applicant from consideration for employment on a basis prohibited by local, state or federal law.
   If I am hired I understand that I am free to resign at any time, with or without cause and without prior notice, and the employer reserves the same right to terminate my employment at any time, with or without cause and without prior notice, except as may be required by law. This application does not constitute an agreement or contract for employment for any specified period or definite duration. I understand that no supervisor or representative of the employer is authorized to make assurances to the contrary and that no implied, oral or written agreement contrary to the foregoing express language are valid unless they are in writing and signed by the employer’s designated representative.
   I also understand that if I am hired, I will be required to provide proof of identity and legal authority to work in the United States and that federal immigration laws require me to complete an I-9 Form in this regard.
   I understand that if I am hired, I will subject to a 90 calendar day probationary period, during this time employment is at-will and may be terminated at any time for any reason with or without cause or notice by either party.
DO NOT SIGN UNTIL YOU HAVE READ THE ABOVE APPLICANT STATEMENT.

I certify that I have read, fully understand and accept all terms of the foregoing Applicant Statement.

Signature of Applicant Date://