Employment Form

Personal Information

First Name *

Middle Name

Last Name *

Phone *

Email *

Address *

Address

City *

State *

Zip Code *

Are you 18 years of age or older? *

Yes

Are you legally eligible to work in the United States? *

Yes

Employment Desired

Position

Date Available to Start

Do you have any experience?

Education

Do you have a high school diploma or GED? *

Yes

Last School Attended *

City *

State *

Field of Study

Highest Level of Education or Degree Earned *

Employment History

Start with your current or most recent employer.

Employer 1

Company Name *

Position *

Address Line 1 *

Address Line 2

City *

State *

Zip *

Start Date *

End Date *

Pay Rate *

Reason for Leaving

Job Duties *

Employer 2

Company Name

Position

Address Line 1

Address Line 2

City

State

Zip

Start Date

End Date

Pay Rate

Reason for Leaving

Job Duties

Employer 3

Company Name

Position

Address Line 1

Address Line 2

City

State

Zip

Start Date

End Date

Pay Rate

Reason for Leaving

Job Duties

May we contact your previous employers? *

Certification and Acknowledgement

I certify that the information provided herein is true and correct to the best of my knowledge. I understand that, if employed, falsified statements on this application for employment form will be considered grounds for termination.

I authorize Witmer Furniture to thoroughly investigate my work experience and any other matters related to my suitability for employment. I further authorize my former employers to disclose to Witmer Furniture any and all information they may have concerning my previous employment. In addition, I hereby release the company, my former employers, and all other persons from any and all claims, demands, or liabilities arising out of, or in any way related to, such disclosure.

I acknowledge that, if employed, both Witmer Furniture and I have the right to terminate the employment relationship at any time, with or without cause or advance notice. This employment at will relationship will remain in effect throughout my employment with the company and may not be modified by any oral or implied agreement.

Applicant's Electronic Signature *

Date *

Witmer Furniture - Employment Application

Personal Information

Employment Desired

Education

Employment History

Certification and Acknowledgement