Employment Form
  1. First Name*
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  2. Last Name*
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  3. Address*
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  4. City*
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  5. State*
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  6. Zip*
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  7. Telephone*
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  8. Email*
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  9. Desired Position*
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  10. Salary Desired
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  11. Date Available*
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  12. Type of Employment*
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  13. Hours Available
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  14. Are you able to peform the essential job functions of the position you are applying with or without reasonable accommodations?*
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  15. If hired, will you be able to work overtime*
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  16. Are you at least 18 years of age?*
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  17. If under 18, do you have a work permit?
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  18. Have you ever been convicted of a crime, excluding misdemeanors and summary offenses, which has not been annulled, expunged or sealed by court? A yes response does not automatically disqualify your application. If yes, please explain*
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  19. Please Explain if Yes
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  20. Education Information


  21. High School / City
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  22. Vocation/Business/Other/ City
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  23. College/university/ City
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  24. College/university/ City
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  25. Graduate/ City
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  26. Other Special Knowledge, Skills otQualifications (list any construction or manufacturing equipment, office skills, technical eq uipment or training
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  27. Military Service (list dates, ranks and training)
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  28. Employment History


    List all employers, starting with the most recent position. All information must be completed.
  29. Most Recent Employer
  30. Is this your current employer?
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  31. May we contact this employer for references?
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  32. Employed From
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  33. Employed To
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  34. Job Title
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  35. Salary
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  36. Employer Name
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  37. Employer Address
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  38. Supervisor's Name
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  39. Supervisor's Phone
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  40. Job Duties and Responsibilities
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  41. Reason for leaving
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  42. Next Most Recent Employer
  43. Employed From
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  44. Employed To
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  45. Job Title
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  46. Salary
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  47. Employer Name
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  48. Employer Address
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  49. Supervisor's Name
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  50. Supervisor's Phone
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  51. Job Duties and Responsibilities
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  52. Reason for leaving
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  53. Next Most Recent Employer
  54. Employed From
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  55. Employed To
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  56. Job Title
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  57. Salary
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  58. Employer Name
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  59. Employer Address
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  60. Supervisor's Name
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  61. Supervisor's Phone
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  62. Job Duties and Responsibilities
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  63. Reason for leaving
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  64. Other Information


  65. Volunteer Activities (list organization, type of service, dates)
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  66. Hobbies, Interests (optional)
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  67. By Submitting this information I agree the above information is true and correct.

    I authorize Shutter America to inquire into my education, past employment history, and references
    as needed to research my qualifications for this position.

    If employed, I will be required to provide original documents which verify my identity and right to work in
    the United States under the Immigration Reform and Control Act (IRCA) of 1986.

    The document(s) provided will be used for the completion of Form I-9. I hereby acknowledge that I have read and agree to the above statements.
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