Tireland Application

Application For Employment
This company is an equal employment opportunity employer. All applicants will be considered without regard to age, color, national origin, religion, disability, sex, or other protected status in accordance with applicable federal and state equal opportunity laws. This company will strive to accommodate any physical or mental limitations of employees or applicants in order to accomplish the essential functions of a job.

Applicant Information
Which location are you applying at?
Position Interested in
Other position interested in:
Date Available For Employment

MonthDayYear
2 digit month, 2 digit day, 4 digit year
Salary Requirements
Work Availability (Check all that apply)
Can you perform the essential functions of the job(s) for which you are applying?
Name

First NameMiddle NameLast Name
Phone Number
Format: (000) 000-0000.
Email
example@example.com
Address

Street Address

Street Address Line 2

CityState

Zip Code
If hired and you are under 18, are you able to provide a work permit?
Are you prevented from lawfully becoming employed in this country because of Visa or Immigration status?
Have you previously been employed by this company?

Driving History
Do you have a valid driver's license?
Driver's License Number
Issuing State
Have you been convicted of a driving while intoxicated violation, had a driver's license restricted or revoked, or been convicted of a moving violation within the last 5 years?
Please provide dates and details below:

Education & Skills
- Name of School
- Highest Grade Completed
- Course of Study
- Name of School
- Did you graduate?
- Degree or Course of Study
- Name of school
- Did you graduate?
- Degree or Course of Study
- Summarize special skills and qualifications, volunteer activities, military experience, employment or other activities related to the job you are seeking, list areas of ASE or other certifications:

Personal/Professional References
List three (3) non-relatives who are familiar with your qualifications, ability, and work history.
Reference 1

First NameLast Name
Occupation/Relationship
Years Known
Phone Number
Format: (000) 000-0000.
Reference 2

First NameLast Name
Occupation/Relationship
Years Known
Phone Number
Format: (000) 000-0000.
Reference 3

First NameLast Name
Occupation/Relationship
Phone Number
Format: (000) 000-0000.
Years Known

Employment History
- Name of Employer
- Employer Phone Number
  Format: (000) 000-0000.
- Supervisor's Name
  
  First NameLast Name
- Address
  
  Street Address
  
  Street Address Line 2
  
  CityState
  
  Zip Code
- Dates of Employment
- Your Job Position
- Starting Pay Rate
- Ending Pay Rate
- Duties
- What did you like most about your job?
- What did you like least about your job?
- What was your reason for leaving this job?
- Do you have any additional previous employers to list?
- Name of Employer
- Supervisor's Name
  
  First NameLast Name
- Employer Phone Number
  Format: (000) 000-0000.
- Address
  
  Street Address
  
  Street Address Line 2
  
  CityState
  
  Zip Code
- Dates of Employment
- Your Job Position
- Starting Pay Rate
- Ending Pay Rate
- Duties
- What did you like most about your job?
- What did you like least about your job?
- What was your reason for leaving this job?
- Do you have any additional previous employers to list?
- Name of Employer
- Supervisor's Name
  
  First NameLast Name
- Employer Phone Number
  Format: (000) 000-0000.
- Address
  
  Street Address
  
  Street Address Line 2
  
  CityState
  
  Zip Code
- Dates of Employment
- Your Job Position
- Starting Pay Rate
- Ending Pay Rate
- Duties
- What did you like most about your job?
- What did you like least about your job?
- What was your reason for leaving this job?
- Do you have any additional previous employers to list?
- Name of Employer
- Supervisor's Name
  
  First NameLast Name
- Employer Phone Number
  Format: (000) 000-0000.
- Address
  
  Street Address
  
  Street Address Line 2
  
  CityState
  
  Zip Code
- Dates of Employment
- Your Job Position
- Starting Pay Rate
- Ending Pay Rate
- Duties
- What did you like most about your job?
- What did you like least about your job?
- What was your reason for leaving this job?

Application Acknowledgements
Please read the following statements carefully before signing this application. Only those applications that are signed and submitted are considered valid. If you have any questions regarding these statements, please ask before signing.
I certify that all answers and statements I have made on this application (including resume or other supplementary materials) are true and complete without omissions. I understand that any false information will be grounds for refusal to hire or for immediate discharge if I am employed. I authorize any of the persons or organizations named in this application to give you complete information and records regarding my employment, education, character, and qualifications.
If hired I will be responsible for familiarizing myself with all rules and regulations of the Company as they presently exist or are later modified. If hired I recognize that my employment can be terminated at the discretion of the Company or at my option, without notice, at any time, except as specifically set forth in writing in a current individual employment agreement.
I also understand that no representative of the Company has any authority to enter into any employment agreement for any specified period of time, or to assure me of any future position, benefits, or terms and conditions of employment, except as specifically stated in a current written agreement signed by the President of the Company.
I understand that this application is not an offer of employment and no promises or representations of employment have been made to me at this time. I understand that my application will be considered valid for ninety (90) days from submission and I must submit a new application after this period.
I have read, understand, and agree with the above statements (Please sign your name below using your mouse by clicking and dragging the cursor in the box below)
Should be Empty:

Application For Employment

Applicant Information

Driving History

Education & Skills

Personal/Professional References

Employment History

Application Acknowledgements