Employment Application

Step 1 of 4

Name*
First Middle Last
Have you ever used another name? If so, what?
First Middle Last
Physical Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Mailing Address (if different from Physical Address)
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Phone*
Email*
Date of Birth*
MM slash DD slash YYYY
Social Security Number*
Desired Salary*
Date Available for Work*
MM slash DD slash YYYY
Position Applied for*
Are you a citizen of the United States?*
- Yes
- No
If no, are you authorized to work in the U.S.?*
- Yes
- No
Have you ever worked for this company?*
- Yes
- No
If so, when?*
Have you ever been convicted of a felony?*
- Yes
- No
If yes, explain*
If so, when?*

Previous Employment
Company
Phone
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Supervisor
First Last
Job Title
Starting Salary
Ending Salary
Responsibilities
From
MM slash DD slash YYYY
To
MM slash DD slash YYYY
Reason for leaving
May we contact your previous supervisor for a reference?
- Yes
- No
Company
Phone
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Supervisor
First Last
Job Title
Starting Salary
Ending Salary
Responsibilities
From
MM slash DD slash YYYY
To
MM slash DD slash YYYY
Reason for leaving
May we contact your supervisor for a reference?
- Yes
- No
References: List three professional references
Name
First Last
Relationship
Company
Phone
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Name
First Last
Relationship
Company
Phone
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Name
First Last
Relationship
Company
Phone
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Contact: List two personal references who you are not related to or former supervisors
Name
First Last
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Phone
Occupation
Years known
Name
First Last
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Phone
Occupation
Years known

Disclaimer and Signature: PLEASE READ CAREFULLY AND SIGN THAT YOU UNDERSTAND AND ACCEPT THIS INFORMATION.
I certify that the information on this application and its supporting documents is accurate and complete. I understand and agree that failure to fully complete the form, or misrepresentation or omission of facts, represents grounds for elimination from consideration for employment, or termination after employment if discovered at a later date. I authorize American Tax Company, LLC. to investigate, without liability, all statements contained in this application and supporting materials. I authorize references and former employers, without liability, to make full response to any inquiries in connection with this application for employment. If requested, I agree to submit to a physical exam, criminal and credit background investigation, and/or screening for illegal substances upon conditional offer of employment. I understand that this document is NOT an offer of employment, and that an offer of employment, if tendered, does NOT constitute a contract for continued guaranteed employment. I understand that staff employees of American Tax Company, LLC. serve at-will, and the employment relationship may be terminated at any time by either party, or any or no reason, other than a reason prohibited by law. If employed, I will be required to furnish proof of eligibility to work in the United States, and to comply with company and departmental regulations. I understand that if employed on a temporary basis, I would be paid for hours worked only, and would be ineligible for benefits including paid time off. I understand that the first FOUR MONTHS of regular employment represent a provisional period, during which I would not be eligible to apply for transfer or promotion and during which I may be terminated without right of appeal. I certify that my answers are true and complete to the best of my knowledge. If this application leads to employment, I understand that false or misleading information in my application or interview may result in my release.
Signature*
Date*
MM slash DD slash YYYY
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