1. Applicant Information


2. Emergency Contact

Who should be contacted if you are involved in an emergency?

3. Job Position Applied For:

4. Who referred you to our company?

Do you have any friends or relatives who work here? If yes, please list here:

5. Salary Desired:

6. Have you applied to our company previously?

If yes, when?

7. Employment Type:

8. Are you willing to work any shift, including nights and weekends?

If no, please state any limitations:

9. Are you at least 18 years old?

10. Are you able to perform the essential functions of the job position you seek with or without reasonable accommodation?

What reasonable accommodation, if any, would you request?

11. If applicable, are you available to work overtime?

12. Have you ever been convicted of a felony or misdemeanor?

I was convicted of
13. If hired, are you able to submit proof that you are legally eligible for employment in the United States?

14. How will you get to work?

15. If you are offered employment, when would you be available to begin work?

16. Applicant's Skills:

17. Applicant Employment History

List your current or most recent employment first. Please list all jobs (including selfemployment and military service) which you have held, beginning with the most recent, and list and explain any gaps in employment. If additional space is needed, continue on the back page of this application.

18. Applicant's Education and Training

If yes, degree(s) received:

19. References

List any two non-relatives who would be willing to provide a reference for you.

20. Please provide any other information that you believe should be considered, including whether you are bound by any agreement with any current employer:


I (Name of The Candidate), certify that the information provided on this application is truthful and accurate. I understand that providing false or misleading information will be the basis for rejection of my application, or if employment commences, immediate termination.

I authorize ALLIED DECCAN INC to contact former employers and educational organizations regarding my employment and education. I authorize my former employers and educational organizations to fully and freely communicate information regarding my previous employment, attendance, and grades. I authorize those persons designated as references to fully and freely communicate information regarding my previous employment and education.

If an employment relationship is created, I understand that unless I am offered a specific written contract of employment signed on behalf of the organization by its CEO, the employment relationship will be "at-will." In other words, the relationship will be entirely voluntary in nature, and either I or my employer will be able to terminate the employment relationship at any time and without cause. With appropriate notice, I will have the full and complete discretion to end the employment relationship when I choose and for reasons of my choice. Similarly, my employer will have the right. Moreover, no agent, representative, or employee of ALLIED DECCAN INC, except in a specific written contract of employment signed on behalf of the organization by its CEO, has the power to alter or vary the voluntary nature of the employment relationship.


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