Dempsey Uniform & Linen Supply

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Apply - Employment Application Form

The following is a form for potential employees of Dempsey Uniform & Linen. Please fill out this form as accurately as possible. All information submitted to Dempsey Uniform is kept confidential. The following information is only used by Dempsey Uniform concerning your potential employment, and if employed; filed under your personal file. Dempsey Uniform is an Equal Opportunity Employer, and does not discriminate in hiring or employment on the basis of race, color, religion, national origin, sex, age, disability, or veteran status. No question on this application is intended to secure information to be used for such discrimination.

General Information:
First Name		Middle Initial
Last Name
Home Address
Home Address (Line 2)		City
State		Zip Code
Home Phone		Work Phone
Other Phone		Email Address
How long have you been at this address?

Employment Information:
Positions Applied for
Salary Desired
Are you 18 years of age or older?		Yes No
Type of Employment Desired?
Have you previously applied for a postion with Dempsey Uniform?		Yes No
If yes, location and dates:
Do you have any family or friends working with Dempsey Uniform?		Yes No
If yes, who:
When would you be able to start working?
Do you have reliable transportation to work?
In the event you are required to use your personal vehicle to conduct company business:
Do you have a valid drivers liscense?		Yes No
Do you have automobile insurance?		Yes No
Do you have any moving violations?		Yes No
If you are a veteran of any branch of the U.S. Armed Forces, did you acquire skills which would be relevant for the position for which you are applying?		Yes No
If yes, describe:
Education and Training:
High School Attended
Graduated?		Yes No
College/University:
Graduated?		Yes No
Date
Type of Degree
Major/Minor
Other Education:
Graduated?		Yes No
Date
Type of Degree
Major/Minor
Security Information
Have you ever been convicted of a felony or misdemeanor?		Yes No
If yes, briefly describe the circumstances or conviction, indicating the date, nature, place of the offence, and disposition of the case
Employment History

Employer Name (1):
Address:
City	State
Zip Code
Phone
Employed From (mo/yr): To (mo/yr):
Job Title:
Pay Rate
Position Description and Duties
Supervisor:
Reason For Leaving:
Are you currently working for the above employer?	Yes No
May we contact your present employer to verify the above?	Yes No

Employer Name (2):
Address:
City	State
Zip Code
Phone
Employed From (mo/yr): To (mo/yr):
Job Title:
Pay Rate
Position Description and Duties
Supervisor:
Reason For Leaving:
Are you currently working for the above employer?	Yes No
May we contact your present employer to verify the above?	Yes No

Employer Name (3):
Address:
City	State
Zip Code
Phone
Employed From (mo/yr): To (mo/yr):
Job Title:
Pay Rate
Position Description and Duties
Supervisor:
Reason For Leaving:
Are you currently working for the above employer?	Yes No
May we contact your present employer to verify the above?	Yes No

Which job did you like most and why?
Which job did you like least and why?
Why do you want to work for Dempsey Uniform?
How did you hear about Dempsey Uniform?
Voluntary Information:
Applicants are considered for employment without regard to race, creed, color, age, religion, sex, national origin, marital status, veteran status, citizenship status, disability, or any other protected category. As a government contractor, we are committed to compliance with applicable government regulations and affirmative action responsibilities. Solely to help us comply with government record keeping, reporting and other requirements, we ask that you assist us by completing this Voluntary Applicant Survey. We appreciate your cooperation. This data is for periodic government reporting and will be kept in a Confidential File.
Sex:
Race:
Veteran Status:
Please Read the Following Statements Carefully
1. I authorize the persons, schools, current employer (if approved by me in the Employment Experience Section) and other organizations or employers named in this application to provide employment decision. 2. I understand and agree that: The information that I have provided is accurate to the best of my knowledge and is subject to verification by Dempsey Uniform. Any misrepresentation for deliberate omission of a fact in my application will be justification for refusal of employment or in employed, termination by Dempsey Uniform. I understand that an offer of employment and my continued employment with Dempsey Uniform are contingent upon satisfactory proof of my authorization to work in the United States. Although management makes every effort to accommodate individual preferences, business needs at times make the following conditions mandatory: overtime, shift work, a rotating work schedule, or a work schedule other than Monday through Friday. 3. I understand that nothing contained in this employment application or in granting of an interview is intended to create an employment contract between myself and Dempsey for either employment or for the providing of any benefit. No promises regarding continued employment have been made to me, and I understand that such promise or guarantee is not binding upon Dempsey unless made in writing. By Typing your full name and date, you agree to the terms and conditions stated above, and that all above information is true to the best of your knowledge.
Full Name:	Today's Date: