Application for Employment
COOKE & ASSOCIATES
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Applications are considered for all positions without regard to race, color, religion, sex, national origin, age, marital or veteran status, or the presence of a non-job related medical condition or handicap. Applicants should be aware that it is our policy to maintain a safe, healthy and productive work place and to that end the testing for substance abuse may be a requirement for a conditional job offer as well as during the course of employment for “cause testing” for substance abuse. Refusal to be tested will prohibit employment or because for termination of employment.
Position Applying For *
Were you referred by someone? If yes, please list their name: *
Full Legal Name *
Telephone Number *
Email Address
Street Address *
City, Sate & ZIP *
Date of Birth *
MM
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DD
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Driver's License Number *
Social Security Number *
Shirt Size (Men's Polo Shirt) *
Are you over 18 years of age? *
If hired, can you furnish proof that you are over 18 years of age? *
Are you a citizen of the United States or a legal resident? *
If hired, can you furnish proof of citizenship/residence? *
Do you have adequate transportation to and from work? *
Guard Card  Number + Expiration Date
Exposed Firearm Permit Number + Expiration Date
Firearm Make, Model, Caliber & Serial Number
Concealed Carry Permit: Issuing Agency + Expiration Date
Education *
Name & Address of School, Degree/Diploma & Graduation Date
Awards, Certificates or Additional Skills *
If none, please use N/A.
EMPLOYMENT HISTORY
List all employers within the past 5 years. Place all requested employer information within employer boxes below.
Current or Most Recent Employer *
Company Name, Start Date - End Date, Position, Duties, Supervisor's Name, Contact Information + Reason for Leaving
Previous Employer
Company Name, Start Date - End Date, Position, Duties, Supervisor's Name, Contact Information + Reason for Leaving
Previous Employer
Company Name, Start Date - End Date, Position, Duties, Supervisor's Name, Contact Information + Reason for Leaving
Previous Employer
Company Name, Start Date - End Date, Position, Duties, Supervisor's Name, Contact Information + Reason for Leaving
REFERENCES
List three non-related references.
Reference #1 *
Name, Title, Years Known, Phone Number + Email Address
Reference #2 *
Name, Title, Years Known, Phone Number + Email Address
Reference #3 *
Name, Title, Years Known, Phone Number + Email Address
Availability *
Please check the box for the days and times you are available to work.
Daytime Hours
Evening Hours
Not Available
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
ACKNOWLEDGEMENT: I certify that the information contained in this application is true, accurate and complete. I understand that any false information may be grounds for non-hire or immediate termination of employment at any point in the future if hired. Cooke & Associates, Inc. does not offer tenure or any other form of guaranteed employment.
By completing your electronic signature below, you agree that your electronic signature is the legally binding equivalent to your handwritten signature. You confirm that the information you provided is true to the best of your knowledge.
Full Legal Name *
Today's Date *
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