Application for Employment atPete Miller'sProprietary and Confidential
Please complete all questions.
Location applying at
1.) Personal Information
Your full name (LAST FIRST INITIAL)
Address line 2
Cell Phone or Other Number You Can Be Reached
2.) Employment Desired
Position being applied for?
When can you report to work?
If you are presently employed, may we contact employer?
Are you legally eligible to be employed in the United States?
(Proof of identity and eligibility will be required upon employment)
What salary/hourly rate do you expect (approximate)?
Have you ever been employed by Pete Miller's before?
If Yes, please complete the following:
Reason for termination of employment
3.) Work Experience
Please List Most Recent First
Previous Employer # 1
Kind of Business
Name of Immediate Supervisor
Reason for Leaving
Previous Employer # 2
Previous Employer # 3
Previous Employer # 4
4.) Education and Skills
Name of School
Subjects Studied or Major
Grade Completed or Degree(s)
List Any Certifications
Any Software Used
Give the names and addresses of persons who know you (not relatives). (We will assume we have your permission to contact these people unless you indicate to the contrary.)
(other than immediate family)
Business or Position
6.) Please Read Very Carefully
I authorize you to communicate with persons listed as references, former employers, and any others with whom you desire to check. I agree to hold such persons harmless with respect to any information they may give about me.
If employed, I agree to engage in no outside activity which would involve a material conflict of interest with, or which could reflect adversely on the Company. I understand this decision is to rest with the Company. If employed, I agree to hold in strictest confidence any information concerning the Company, its Insureds, and its Agents which may come to my knowledge.
In consideration of my employment, if I am employed, I agree to conform to the employment policies of the Company, and I understand that my employment and compensation can be terminated, with or without notice, at any time, at the option of either the Company or myself. I understand that no representative of the Company, other than the President, has the authority to enter into any agreement for employment for any specified period of time, or to make any agreement contrary to the foregoing.
I understand that completion of this Application For Employment does not guarantee that I have been employed by this Company.
I understand that applicants will receive consideration for position, without regard to race, color, religion, age, sex (except where sex is a bonafide occupational qualification), sexual orientation, marital status, individuals with disabilities, and membership in the Uniformed Services.
I hereby affirm that my answers to these statements and questions are true and correct to the best of my knowledge. I have not knowingly withheld any fact or circumstance that would, if disclosed, affect my application unfavorably.
I understand that any misrepresentation, deception, or false statement made in this Employment Application may result in my not being considered for employment, and if not discovered by the Company until after my becoming employed, is grounds for, and may result in, my immediate termination.
I understand that the Company may require the successful completion of a urinalysis for drug testing purposes and/or a blood alcohol test as a condition of employment. By submitting this Application for Employment, I hereby consent to either or both of said tests, at the Company/s discretion.
By typing your name in the field below you are signing this electronic document.
7.) Request for Transcript of Academic Records
I hereby authorize the educational institutions listed on the Employment Application to release a copy of my official transcript of my academic record.
* Please copy the text as shown into the box to verify