Online Employment Application

First Name:

Last Name:

Social Security Number:

Street Address:

City:   State:    Zip:

Home Phone:  

Other Phone:

Are you at least 18 Years of Age? Yes   No

Each applicant will be given employment consideration based on individual merit, without regard to the individual's race, color, religion, sex, national origin, the presence of a non-job related medical condition or handicap, or other categories governed by applicable law. We are an equal opportunity employer.

Position Desired:

Salary Desired:

Date Available:

Have you ever worked for Barry Ward  before? No   Yes

Have you ever applied at Barry Ward before? No   Yes

Are you related to anyone at Barry Ward? No   Yes

Are you currently employed? No   Yes

If so, will your current employer give you a reference now? No   Yes

EMPLOYMENT HISTORY
(LIST YOUR LAST FOUR EMPLOYERS, BEGINNING WITH THE CURRENT OR MOST RECENT ONE FIRST.)

   Dates of Employment
1. From:     to:    

Name, address and phone number of Employer:

Beginning Salary: End Salary:

Position:

Reason for Leaving:

• • • • • • •

2. Dates of Employment

From:     to:    

Name, address and phone number of Employer:

Beginning Salary: End Salary:

Position:

Reason for Leaving:

• • • • • • •

Dates of Employment
3. From:     to:    

Name, address and phone number of Employer:

Beginning Salary: End Salary:

Position:

Reason for Leaving:

• • • • • • •

4. Dates of Employment

From:     to:    

Name, address and phone number of Employer:

Beginning Salary: End Salary:

Position:

Reason for Leaving:

Do you have any physical or mental limitations which would restrict your job performance? No      Yes

If yes, Explain:

Are you willing to take a pre-employment physical examination? 
Yes   No

Are you willing to take a pre-employment substance abuse test?
Yes   No

EDUCATION

High School Attended:
High School Location (city/state):
Did you graduate? Yes  No

College or University Attended?
College School Location (city/state):
Did you graduate? Yes  No
If yes, what was your major?

Please list all software and hardware that you have experience with.

REFERENCES - list three people not related to you who have known you for at least two years.

Fill in name, address and phone number for all three references.

1.    

2.    

3.    

List any special qualifications, computer skills or other experience that you would like us to know about.
 

I certify that the information contained in this application is correct to the best of my knowledge and understand that falsification of this information is grounds for refusal to hire, or, if hired, dismissal. I authorize investigation of all statements contained in this application. I understand that this application is not and is not intended to be a contract of employment. I understand and agree that my employment is for no specific period of time and may, regardless of the date of payment of my salary, be terminated at any time without pervious notice.