Position Applied for:

• Interview Date
• Interview Time

• * First Name:
• MI:
• * Last Name:

• Address - No. & Street:
• City:
• State: Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming
• Zip Code:

• Home Telephone:
• Business Telephone:
• Cell Phone:

• * Email Address:

Highest Education Level:

• Less than High School
• Bachelor's
• High School Graduate
• Some Graduate
• Associate
• Master's
• Technical School
• Doctorate (MD, DDS, JD)
• Some College
• Post-Doctorate

• Degree:
• Yr. Earned:
• Major:
• School:
• State:
• Country:

• Degree:
• Yr. Earned:
• Major:
• School:
• State:
• Country:

If you are under 18, and it is required, can you furnish a work permit: Yes No   N/A:

Previously Employed by Einstein Industries, Inc.: Yes No   If yes, give dates and position:

Are you currently authorized to work in US? Proof of eligibility will be required if hired. Yes No

Desired Work Status: Temporary Part-Time Full-Time

Are you able to meet the attendance requirements of the position? Yes No

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, please provide date(s) and details:

Note: No applicant will be denied employment solely on the grounds of conviction of a criminal offense. The nature of the offense, the date of the offense, the surrounding circumstances and the relevance of the offense to the position(s) applied for may, however, be considered.

EMPLOYMENT HISTORY (Related Experience): List present or most recent experience first

• Employer Name:
• Employer Address:
• Phone Number:
• Supervisor's Name:
• Ending Job Title:
• From To
• Ending Pay Rate:
• Pay Frequency(hr/wk/mo/yr):
• Reason For Leaving:
• Duties:

• Employer Name:
• Employer Address:
• Phone Number:
• Supervisor's Name:
• Ending Job Title:
• From To
• Ending Pay Rate:
• Pay Frequency(hr/wk/mo/yr):
• Reason For Leaving:
• Duties:

• Employer Name:
• Employer Address:
• Phone Number:
• Supervisor's Name:
• Ending Job Title:
• From To
• Ending Pay Rate:
• Pay Frequency(hr/wk/mo/yr):
• Reason For Leaving:
• Duties:

• Employer Name:
• Employer Address:
• Phone Number:
• Supervisor's Name:
• Ending Job Title:
• From To
• Ending Pay Rate:
• Pay Frequency(hr/wk/mo/yr):
• Reason For Leaving:
• Duties:

REFERENCES: It is our procedure to check references. If you do not wish to have your current employer/supervisor contacted, please check the box below. Do not contact my present employer.

• Name:
• Phone:
• Employer/Title:
• Address:

• Name:
• Phone:
• Employer/Title:
• Address:

• Name:
• Phone:
• Employer/Title:
• Address:

Applicant Statement

I certify that all information I have provided in order to apply for and secure work with the employer is true, complete and correct. I understand that any information provided by me that is found to be false, incomplete or misrepresented in any respect, will be sufficient cause to (i) cancel further consideration of this application, or (ii) immediately discharge me from the employer’s service, whenever it is discovered.

I expressly authorize, without reservation, the employer, its representatives, employees or agents to contact and obtain information from all references (personal and professional), employers, public agencies, licensing authorities and educational institutions and to otherwise verity the accuracy of all information provided by me in this application, resume or job interview. I hereby waive any and all rights and claims I may have regarding the employer, its agents, employees or representatives, for seeking, gathering and using such information in the employment process and all other persons, corporations, organizations for furnishing such information about me.

I understand that this application remains current for only 30 days. At the conclusion of that time, if I have not heard from the employer and still wish to be considered for employment, it will be necessary to reapply and fill out a new application.

If I am hired, I understand that Einstein Industries, Inc is an at-will employer and that I am free to resign at any time, with or without cause and without prior notice, and the employer reserves the same right to terminate my employment at any time, with or without cause and without prior notice, except as may be required by law. This application does not constitute an agreement or contract for employment for any specified period of definite duration. I understand that no supervisor or representative of the employer is authorized to make any assurance to the contrary and that no implied, oral or written agreements contrary to the foregoing express language are valid unless they are in writing and signed by the employer’s president.

I also understand that if I am hired, I will be required to provide proof of identity and legal authority to work in the United States and that federal immigration laws require me to complete an I-9 when I begin work.

By submitting this application, you have agreed to be bound by the Uniform Electronic Transaction Act and understand that the electronic submission is as legally binding as though you have signed and returned such application.  If you do not wish to be bound by the UETA, then you must print, sign, and return the application by mail.

I Agree