EMPLOYMENT APPLICATION FORM

"*" indicates required fields

Personal Information

Provide full legal name as it appears on identification*
Physical street address (do not use post office box)
Mailing address if different than physical address

Employment Preferences

Shift(s) available to work*
Day(s) available to work*
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General Information

At least 18 years of age*
Authorized to work in the United States*
Reliable Transportation*

Education

Highest level of education completed*
Details on highest level of education completed

Temporary Employment

Most recent temporary employment history
Agency Name
Company Name
Worksite Address
Position
 

Employment

Most recent permanent employment history
Start Date
End Date
Company Name
Position
Reason for Leaving
 

Voluntary Participation in E-Verify

Empire Workforce Solutions does not participate in E-Verify at a branch level; therefore, it is not required for employment purposes. Empire Workforce Solutions from time to time does place employees at companies that require employees to be E-Verified to work at their locations. Employees who are not E-Verified will be disqualified from working at such locations. To provide employees the opportunity to work at companies that require employees to be E-Verified, Empire Workforce Solutions offers to send employee information to a Verification Center where the E-Verification process is completed. Participation in E-Verify is completely voluntary; employment eligibility will not be affected if the employee does not wish to participate.
If hired, would you like Empire Workforce Solutions to send your information to a Verification Center to complete the E-Verification process?*

Americans with Disabilities Act

Empire Workforce Solutions complies with the Americans with Disabilities Act (ADA) and will provide reasonable accommodations whenever possible and necessary to perform the essential functions of the job. Employees may be subject to medical examinations and skill & agility testing as required for employment purposes.
Are you able to perform the essential functions of the job for which you are applying, either with or without reasonable accommodation?*

Disclosures

True and Complete Information
I acknowledge that the information provided by me on this Employment Application is true and complete and I have not withheld any information that might adversely affect my opportunity for employment with Empire Workforce Solutions. I understand that it is grounds for immediate termination of employment if any information is found untrue, misleading or if I omit material facts.*
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