Employment Application Basic InformationName* First Middle Last Address* Street Address Address Line 2 City StateAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Phone*Email* Position Applied For* Date Available* MM slash DD slash YYYY How did you hear about us? Want ad PSU website Other Website Walk-in Employee Facebook Other What was the name of the employee? Authorization to WorkAre you a U.S. Citizen?* Yes No Are you authorized to work in the U.S.? Yes No Driver's LicenseDo you have a valid driver's License?* Yes No Are you willing and able to secure a Driver’s License if required? Yes No Have you ever had a certification or license (excluding a driver’s license) suspended or revoked?* Yes No EligibilityHave you ever worked for this company?* Yes No When did you work for this company? Do you have relatives who working at this company?* Yes No When did they work for this company? Have you ever been convicted of a crime?* Yes No Please explain Education: High SchoolHigh school name High school address Street Address Address Line 2 City StateAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Starting Date MM slash DD slash YYYY Ending Date MM slash DD slash YYYY Did you graduate?* Yes No Diploma Education: CollegeCollege Information College Name Actions Edit Delete There are no colleges. Add college Maximum number of colleges reached. Licensure/Certification/RegistrationLicense Type/Level/Grade Actions Edit Delete There are no Licenses. Add License Maximum number of licenses reached. ReferencesPlease include at least 3References Name Actions Edit Delete There are no References. Add Reference Maximum number of references reached. Previous EmploymentPrevious Jobs Company Name Actions Edit Delete There are no Jobs. Add Job Maximum number of jobs reached. Military ServiceDo you currently or have you ever served in the military?* Yes No Banch Start date MM slash DD slash YYYY End date MM slash DD slash YYYY Rank at discharge Type of discharge If other than honorable, explain:Additional InformationPlease summarize any other experience, skills, or qualifications which you feel would qualify you for the position for which you have applied (e.g. professional organizations, clerical skills, computer abilities, etc.).Equal Opportunity EmploymentThese questions are included to assist our equal opportunity efforts. Providing this information is VOLUNTARY and will in no way affect the processing of your application or your being considered for employment. Human Resources will process your responses to these confidential questions separately. Responses will be used for statistical purposes only.Do you want to answer questions about your sex, age, and race? Yes No Sex Male Female Age Under 18 18-25 26-39 40-54 55-69 70+ Race/ethnicity WHITE (Not of Hispanic Origin): All Persons having origins in any of the original people of Europe, North Africa or the Middle East. BLACK or AFRICAN AMERICAN (Not of Hispanic origin): All persons having origins in any of the Black racial groups of Africa. HISPANIC or LATINO: All persons of Mexican, Puerto Rican, Cuban, Central or South America or other Spanish culture or origin, regardless of race. ASIAN: All persons having origins in any of the original people of the Far East, Southeast Asia, the Indian Sub-continent (for example China, India, Japan, and Korea.) NATIVE HAWAIIAN or PACIFIC ISLANDER: All persons having origins in any of the original people of the Hawaiian Islands and Pacific Islands (for example, Hawaii, Philippine Islands and Samoa). AMERICAN INDIAN or ALASKAN NATIVE: All persons having origins in any of the original people of North America and who maintain cultural identification through tribal affiliation or community recognition. TWO OR MORE RACES: All persons having origins from more than one of the above categories. Are you an individual with a physical or mental impairment which substantially limits one or more of your major life activities? Yes No Are you a veteran? Yes No Please indicate if one or more of the following apply. Disabled Veteran Vietnam Era Veteran Desert Storm/Shield Veteran CAPTCHA Δ