Employment Application Form

Personal Data:

 

 
Last name
Middle Name
First Name
Previous name(s)
 
 
Permanent address
How long at current address?
E-Mail
Address 2
Primary Phone Number
Alternate Phone Number
City
Desired Salary range
How were you referred?

 

State
Zip:
Position desired
Date available for work
 
 

 
Type of employment desired
Are you available to work evenings?
Are you willing to travel?
Are you willing to relocate?
Full Time
Part Time
Yes
No
Yes
No
Yes
No
Temporary
Seasonal
 
 
 
 
 
 

 
Are you at least 18 years of age?
Are you available to work weekends?
Do you have a legal right to work in the United States?
Are you able to meet the attendance requirements of this position?
Yes
No
Yes
No
Yes
No
Yes
No

 
Have you ever plead 'guilty' or 'no contest' or been convicted of a crime?
If 'Yes' please provide details including date(s) city, state and charge.
Have you ever worked for Midtown Express or its affiliates?
If 'Yes' give dates, location and position.
Yes
No
 
Yes
No
 

 

 
 
 

 

 

Address History:

Please list address for the past seven years

 
Previous address
Previous address
Previous address
Street

City, State, Zip

Dates
From
To
From
To
From
To

 

 

 
Present or last employer
Previous employer
Previous employer
Name of Employer

City, State of employer

Job title, duties

Supervisors name

Supervisors phone

 
From
To
From
To
From
To
Salary
 
From
To
From
To
From
To
Dates of employment
Reason for leaving

 

 

Professional References:

Include only individuals that are familiar with your work ability. Do not include relatives

 
Name
Phone Number
Association
No. of years known
1.

2.

3.

 

 

Education:

Beginning with High School, list each school attended

 
School name & location
(city, state and country if not in US)
Major course of study
Check last year completed
Degree/Certificate
1
2
3
4
High School/Ged

College/Trade School

Graduate School

 

 

Skills:

Please list any skills or training you have completed which will aid in evaluating your qualifications for the position you are seeking.

 

Skills:
Professional Certificates/Affiliations:

 

 

 

Attach your resume:

You may attach a copy of your resume in Word, or plain text format here. Type the path and file name in the field or select the browse button to locate your file.

 

 

 

 

Applicant release and privacy statement:

Please read carefully before clicking "Submit".

 

Nature of Employment: If I am hired, I understand 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 or definite duration. I understand that no supervisor or representative of the employer is authorized to make any assurances 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.

Certification of Accuracy Statement: I certify that all information that I have provided on this application, related papers and in interviews 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 the application, (ii) rescind an employment offer, (iii) immediately discharge me from Midtown Express, Inc.’s or its affiliates service, whenever it is discovered. I expressly authorize, without reservation, the employer and/or its representatives, including employees, agents and consumer reporting bureaus, to contact and obtain information from all references, employers, public agencies, licensing authorities and educational institutions and to otherwise verify the accuracy of all information provided by me in the application, resume or job interview. I hereby waive any and all rights and claims I may have regarding the employer, its agent, employees or representatives, for seeking, gathering and using such information in the employment process and other person, corporations or organizations for furnishing such information about me.

I understand that Midtown Express, LLC and its affiliates do not discriminate against any employee or applicant for employment and no question on this application is used for the purpose of limiting or excusing any applicant from consideration for employment on a basis prohibited by applicable local, state or federal law. I understand that is the policy of Midtown Express, LLC and its affiliates to provide equal employment opportunity to all qualified applicants and employees, without regard to race, color, national origin, religion, gender, age, disability, veteran status or any other characteristic otherwise protected by law.

I understand that this application will remain current for 30 days; after that time, if I have not heard from the employer and still wish to be considered for employment, it will be necessary to complete a new application.

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

By selecting the Submit button below, I certify that I have read, fully understand and accept all terms of the forgoing Applicant Release and Privacy Statement.

 

 

 

Midtown Express, LLC. • 56-17 58th Street • Maspeth, NY 11378
718.326.6900 phone • 718.326.4258 fax