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>
Employment
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Employment Application
Employment Application
Personal Information
Last Name*
First Name*
Middle Name
Email
Last 4 Digits Social Security Number*
Present Address*
City*
State*
Zip Code*
Phone*
18 or Older*
Yes
No
Lawfully Permitted to Work in US*
Yes
No
Other Names Used
Application Information
Type of Employment*
Year Round
Permanent
Summer
Temporary
Position(s) Applied For*
Rate of Pay Expected*
Days and Hours Available*
Start Date*
Method of Transportation*
Valid Drivers License*
Yes
No
Drivers License State and Number
Employment Information
Employed Now*
Yes
No
Current Employer
Current Job Title
Current Job Duties
Current Job Pay Rate
Applied to Clarion Before*
Yes
No
Applied to Clarion When
Why Change Jobs?*
Contact Current Employer
Yes
No
On Layoff or Subject to Recall*
Yes
No
Worked For Clarion Before*
Yes
No
Worked for Clarion When
Clarion Supervisor Name
Reason for Leaving Clarion Before
Able to Perform Duties of Job Applied For*
Yes
No
Ever Been Bonded*
Yes
No
Bonded on What Jobs
Ever Been Discharged*
Yes
No
Discharge Explanation
Ever Been Convicted*
Yes
No
Conviction Details
Ever Served in Military*
Yes
No
Service Branch
Armed Services Discharge Date
Armed Services Discharge Type
References
Reference Number 1*
Referred By
Reference Number 2*
Education Information
Last Year Completed - Elementary School*
5
6
7
8
Last Year Completed - High School*
1
2
3
4
Last Year Completed - College
1
2
3
4
Post-College?
Yes
No
Name of College Attended
Returning to College
Yes
No
Returning to College When
Driving Record
Licenses Possessed
License Number
License State
Points/Convictions in Last 5 Years
Employment History
Employers Excluded from Contacting and Reasons
Most Recent Employer
Employer 1 Name*
Address*
Phone Number*
Immediate Supervisor*
Date of Hire*
Date Left*
Starting Pay*
Ending Pay*
Title and Duties*
Reason for Leaving*
Third Most Recent Employer
Employer 3 Name
Address
Phone Number
Immediate Supervisor
Date of Hire
Date Left
Starting Pay
Ending Pay
Title and Duties
Reason for Leaving
Second Most Recent Employer
Employer 2 Name
Address
Phone
Immediate Supervisor
Date of Hire
Date Left
Starting Pay
Ending Pay
Title and Duties
Reason for Leaving
Applicant's Agreement and Certification
Applicant Certification of Honesty*
I certify that the information given by me in this application is true and complete in all respects and I agree that if employed and it is found to be false or incomplete in any way, I may be subject to dismissal without notice, if and when discovered.
I hereby authorize the Company to conduct an investigation concerning all statements contained in my application for employment, to interview all employers and to conduct any other investigation that it deems appropriate. I further authorize past employers, all references and any other persons to answer all questions asked by the Company concerning my ability, character, reputation and previous employment record. I release all such persons from any liability or damages on account of having furnished such information. I request any duly constituted law enforcement agency or judicial officer to furnish the Company with all information pertaining to me concerning unexpunged convictions and I hereby release the Company and any law enforcement agency judicial or other individual from any liability arising from disclosure of such information pertaining to me which is obtained during said investigation. I agree, if employed, to comply with all lawful instructions of my supervisors and to abide by all present and subsequently issued rules and personnel policies of the Company. I further agree that (1) 1 will work faithfully and diligently, (2) be careful and avoid accidents, (3) come to work on time and (4) not be absent for any reason without three hours prior notice to my supervisor.
I understand and agree that my employment is for no definite period and may be terminated at any time without cause and without any previous notice. I understand and agree that upon termination of employment, the Company may answer truthfully all questions asked by any prospective employer concerning my ability, character, reputation and employment record and I release the Company, its agents and employees from any liability or damages on account of having furnished such information.
Applicant Acknowledgement of Polygraph Regulation*
That under Maryland Law, an employer may not require or demand any applicant for employment or prospective employment or any employee to submit to or take a polygraph, lie detector or similar test or examination as a condition of employment or continued employment. Any employer who violates this provision is guilty of a misdemeanor and subject to a fine not to exceed $100.
Digital Signature - By entering my name below, I certify that all information furnished in this application is true and complete to the best of my knowledge. *
Thank you!
Your application has been sent.