| Your Identity |
| Today's Date |
|
| Last Name | |
| First Name | |
| Middle Initial | |
| Present Address | |
| City | |
| State | |
| Zip | |
Permanent Address
(if different from present address) | |
| City | |
| State | |
| Zip | |
| Business Phone Number | () - |
| Home Phone Number | () - |
| Social Security Number | - - |
| Email Address | |
| Desired Position |
| Position | |
| Availability | |
| Have you ever applied to or worked for WESTPORT PROPERTIES, INC. before? | Yes No |
| If yes, when? |
|
| Do you have any friends or relatives working for WESTPORT PROPERTIES, INC.? | Yes No |
| If yes, state name(s) and relationship: | Name: Relationship: |
| | Name: Relationship: |
| Why are you applying for work at WESTPORT PROPERTIES, INC.? | |
| If hired, would you have a reliable means of transportation to and from work? | Yes No |
| Are you at least 18 years old? (If under 18, hire is subject to verification that you are of minimum legal age.)
| Yes No |
| If hired, can you present evidence of your U.S. citizenship or proof of your Legal right to live and work in this country? | Yes No |
| Are you able to perform the essential functions of the job for which you are Applying, either with or without reasonable accommodation? | Yes No |
| If no, describe the functions that cannot be performed. | |
| Note: We comply with the ADA and consider reasonable accommodation measures that may be necessary for eligible applicants/employees to perform essential functions. Hire may be subject to passing a medical examination, and to skill and agility tests. |
| Have you ever been convicted of a criminal offense (felony or serious misdemeanor)? (Convictions for marijuana-related offenses that are more than two years old need not be listed.) | Yes No |
| If yes, state nature of the crime(s), when and where convicted and disposition of the case. | |
| Note: No applicant will be denied employment solely on the grounds of conviction of a criminal offense. The nature of the offense, date of the offense, the surrounding circumstances and the relevance of the offense to the position(s) applied for may, however, be considered. |
| Your Education |
| High School Name: | |
| Address | |
| City | |
| State | |
| ZIP | |
| Number of years completed: | |
| Did you graduate? | Yes No |
| Did you receive a GED or diploma? | GED Diploma |
| Vocational / Business Name: | |
| City | |
| State | |
| ZIP | |
| Number of years completed: | |
| Did you graduate? | Yes No |
| Did you receive a diploma? | Yes No |
| College / University Name: | |
| City | |
| State | |
| ZIP | |
| Number of years completed: | |
| College degree? | No AA BA BS |
| Employment History - Most Recent |
| Begin with your most recent experience. List below all present and past employment starting with your most recent employer (last five years is sufficient). Account for all periods of unemployment. You must complete this section even if attaching a resume. |
| Length of Employment | From:
To:
|
| Company Name | |
| Address | |
| City | |
| State | |
| Zip | |
| Salary Range | Starting: Ending: |
| Supervisor's Name | First: Last: |
| Supervisor's Phone | () - Ext: |
| Position | |
| Please describe your position and duties. | |
| Please describe your reason for leaving. | |
| May we contact your past employers? | Yes No |
| Employment History (Past employment 2) |
| Length of Employment | From:
To:
|
| Company Name | |
| Address | |
| City | |
| State | |
| Zip | |
| Salary Range | Starting: Ending: |
| Supervisor's Name | First: Last: |
| Supervisor's Phone | () - Ext: |
| Position | |
| Please describe your position and duties. | |
| Please describe your reason for leaving. | |
| May we contact your past employers? | Yes No |
| Employment History (Past employment 3) |
| Length of Employment | From:
To:
|
| Company Name | |
| Address | |
| City | |
| State | |
| Zip | |
| Salary Range | Starting: Ending: |
| Supervisor's Name | First: Last: |
| Supervisor's Phone | () - Ext: |
| Position | |
| Please describe your position and duties. | |
| Please describe your reason for leaving. | |
| May we contact your past employers? | Yes No |
| Personal Reference 1 |
| Name | First: Last: |
| Address | |
| City | |
| State | |
| Zip | |
| Phone Number | () - |
| Occupation | |
| Years Known | |
| Personal Reference 2 |
| Name | First: Last: |
| Address | |
| City | |
| State | |
| Zip | |
| Phone Number | () - |
| Occupation | |
| Years Known | |
| Personal Reference 3 |
| Name | First: Last: |
| Address | |
| City | |
| State | |
| Zip | |
| Phone Number | () - |
| Occupation | |
| Years Known | |
| Your Authorization is Required |
| Please type your initials into the corresponding box to the left of each statement below. By electronically initialing each box, you acknowledge that you have read and understand the terms within. |
| I hereby certify that I have not knowingly withheld any information that might adversely affect my chances for employment and that the answers given by me are true and correct to the best of my knowledge. I further certify that I, the undersigned applicant, have personally completed this application. I understand that any omission or misstatement of material fact on this application or on any document used to secure employment shall be grounds for rejection of this application or for immediate discharge if I am employed, regardless of the time elapsed before discovery. |
| I hereby authorize the company to thoroughly investigate my references, work record, education and other matters related to my suitability for employment and, further, authorize the references I have listed to disclose to the company any and all letters, reports and other information related to my work records, without giving prior notice of such disclosure. In addition, I hereby release the company, my former employers and all other persons, corporations, partnerships and associations from any and all claims, demands or liabilities arising out of or in any way related to such investigation or disclosure. |
| I understand that nothing contained in the application, or conveyed during any interview which may be granted or during my employment, if hired, is intended to create an employment contract between me and the company. In addition, I understand and agree that if I am employed, my employment is for no definite or determinable period and may be terminated at any time, with or without prior notice, at the option of either myself or the company, and that no promises or representations contrary to the foregoing are binding on the company unless made in writing and signed by me and the company’s designated representative. |
