Employment Application

Personal Information

Full Name (First, Middle Initial, Last)
(required)

Street Address
(required)

City/State/Zip
(required)

Email Address

Home Phone

Cell Phone

May we contact you via text message?

Yes
No

Are you employed now?

(required)

Yes
No

If so, may we inquire of your present employer?

(required)

Yes
No

Can you, upon employment, submit verification of your legal right to work in the United States and documentation verifying your identity?

If offered employment and accepted, you are required by law to show proof of eligibility to work in the United States. (required)

Yes
No

Referred By
(required)

If referred by GSCU Employee, please provide their name.

Position Applying For

Preferred Location(s)

Part-Time
Full-Time

Salary Desired

Date Available
(required)

If you are related to anyone working for GSCU please provide their name.

Education

High School
(Name, City, State)

High School Diploma

Yes
No

Undergraduate College (please specify degree/major)

Undergraduate Diploma

Yes
No

Please list other education, such as Business, Technical, or Graduate School. (Please specify degree/major.)

Other Diploma (for degree indicated above)

Yes
No

Work Experience

Please list your last three employers, starting with your present or last place of employment.

Current/Most Recent Employer: Company Name, Address, Phone

Start and End Dates (Employer #1)

Position Title and Salary (Employer #1)

Reason for leaving (Employer #1)

Employer #2: Company Name, Address, Phone

Start and End Dates (Employer #2)

Position Title and Salary (Employer #2)

Reason for leaving (Employer #2)

Employer #3: Company Name, Address, Phone

Start and End Dates (Employer #3)

Position Title and Salary (Employer #3)

Reason for leaving (Employer #3)

Business References

Please do not list relatives. Individuals with no prior work experience may list school or volunteer-related references.

Reference #1: Name of Company

Reference #1: Person to contact (Name, Title, Phone Number, and Email Address)

Reference #2: Name of Company

Reference #2: Person to contact (Name, Title, Phone Number, and Email Address)

Reference #3: Name of Company

Reference #3: Person to contact (Name, Title, Phone Number, and Email Address)

Other Information

US Military or Naval Service (please specify rank)

Present Membership in National Guard/Reserves

Please indicate any relevant specialized skills (i.e. computer programming/language, software, special tools or machines, etc.)

If position requires driving, do you hold a valid drivers license?

Yes
No

Have you been convicted of a crime that has not been annulled?

Note: A conviction will not necessarily be a bar to employment.

Yes
No

If yes, please explain

Acknowledgements

Please read carefully, confirm the following statements, then sign below.

I understand that it is GSCU's policy that I must complete an application in full including employment history with salary information as well as references. "See Resume" is not acceptable.

I am aware that it is GSCU's policy to verify my education and previous employment information (including salary) through reference checks, background checks and other means. I understand that I will be required to provide this information if requested.

I certify that I have not knowingly withheld information that might adversely affect my chances for employment and that the answers given by me are true and correct to the best of my knowledge. I further certify that I, the undersigned applicant, have personally completed this application. I understand that any omission or misstatement of material fact on this application or on any document used to secure employment shall be grounds for rejection of this application or for immediate discharge if I am employed, regardless of the time elapsed before discovery.

I hereby authorize GSCU to thoroughly investigate my references, work record, education and other matters related to my suitability for employment and, further, authorize the references I have listed to disclose to GSCU any and all information related to my work records, without giving me prior notice of such disclosure. In addition, I hereby release GSCU, my former employers and all other persons, corporations, partnerships and associations from any and all claims, demands or liabilities arising out of or in any way related to such investigation or disclosure.

If employed, I agree to abide by all of GSCU's policies and procedures. I understand that nothing contained in the application or conveyed during any interview that may be granted during my employment, if hired, is intended to create an employment contract between GSCU and myself. In addition, I understand and agree that if employed, my employment is for no definite period and may be terminated at any time for any reason or no reason at all, with or without prior notice, at the option of either GSCU or myself, and that no promises or representations to the contrary are binding on GSCU unless made in writing and signed by GSCU's Chief Executive Officer and me.

I understand that, if employed, I will be required to complete the U.S. Department of Justice immigration and Naturalization Service Form I-9 and to provide the required supporting documentation to verify my eligibility to work in the United States. I understand that GSCU uses eVerify, a service of the Social Security Administration and Department of Homeland Security, to determine whether form I-9 documentation is valid.

Applicant's Electronic Signature

Date

Resume

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