IC Employment Form

Employment Job Application 2025

IC APPLICATION FOR EMPLOYMENT
IC is an equal opportunity employer. IC does not discriminate in employment with regard to race, color, religion, national origin, citizenship status, ancestry, age, sex (including sexual harassment), sexual orientation, marital status, physical or mental disability, military status or unfavorable discharge from military service or any other characteristic protected by law.

PERSONAL INFORMATION
Incomplete information could disqualify you from further consideration. Please complete all fields.
Name
First Middle Last
Date of Application*
MM slash DD slash YYYY
Email Address:*
Phone #:*
Address*
Street Address City State / Province / Region ZIP / Postal Code
Are you eligible to work in the U.S.?*
- Yes
- No
Are you at least 18 years or older?*
(If not, you may be required to provide authorization to work.)
- Yes
- No
Have you ever been terminated from employment or asked to resign by an employer?*
- Yes
- No
If yes, please provide company names and details
Can you work any shift?
- Yes
- No
If no, explain:
Are you able to perform the essential functions of the job for which you are applying, with or without reasonable accommodation?
- Yes
- No
How did you hear about us?
- Walk In
- Advertisement
- Referral
- Other
Have you ever worked for this company before?
- Yes
- No
Position & Supervisor:
EMPLOYMENT DESIRED
Date you can start*
Month
Day
Year
Hourly rate/Salary desired*
Position desired
Are you currently employed?*
- Yes
- No
If so, may we inquire of your present employer?
Do you have any special skills, experience and/or training that would enhance your ability to perform the position applied for? If yes, explain.
- Yes
- No
If you answered Yes above, please indicate below*
Educational Background
High School Education
Name and location of school Degree Received Subjects studied/Major
College or University Education
Name and location of school Degree Received Subjects studied/Major
Employment History
Include your last seven (7) years of employment history, including periods of unemployment, starting with the most recent and working backwards in time. Incomplete information could disqualify you from further consideration.
Employer #1
Employer Name*
Employment Date From*
MM slash DD slash YYYY
Employment Date To*
MM slash DD slash YYYY
Employer Phone Number*
Employer Address*
Street Address City State ZIP Code
Immediate Supervisor Name and Title*
Summarize the nature of work performed and job responsibilities*
Reason for leaving*
Employer #2
Employer Name
Employment Date From
MM slash DD slash YYYY
Employment Date To
MM slash DD slash YYYY
Employer Phone Number
Employer Address
Street Address City State ZIP Code
Immediate Supervisor Name and Title
Summarize the nature of work performed and job responsibilities
Reason for leaving
Employer #3
Employer
Employment Date From
MM slash DD slash YYYY
Employment Date To
MM slash DD slash YYYY
Employer Phone Number
Employer Address
Street Address City State ZIP Code
Immediate Supervisor Name and Title
Summarize the nature of work performed and job responsibilities
Reason for leaving
REFERENCES
REFERENCES*
Give the names of three persons not related to you, whom you have known at least three (3) years
Name Address, Phone, Email Company Years Acquainted
REFERENCE 2*
Name Address, Phone, Email Company Years Acquainted
REFERENCE 3*
Name Address, Phone, Email Company Years Acquainted
Consent*
Please read carefully before signing*
I understand that neither the completion of this application nor any other part of my consideration for employment establishes any obligation for IC to hire me. If I am hired, I understand that either IC or I can terminate my employment at any time and for any reason, with or without cause and without prior notice. I understand that no representative of IC has the authority to make any assurance to the contrary.

I attest with my signature below that I have given to IC true and complete information on this application. No requested information has been concealed. I authorize IC to contact references provided for employment reference checks. If any information I have provided is untrue, or if I have concealed material information, I understand that this will constitute cause for the denial of employment or immediate dismissal.
Signature*
Date*
MM slash DD slash YYYY
THIS APPLICATION IS VALID ONLY FOR 60 DAYS FROM THE DATE ABOVE.
Name
This field is for validation purposes and should be left unchanged.

Name and location of school	Degree Received	Subjects studied/Major

IC Employment Form

Employment Job Application 2025

IC APPLICATION FOR EMPLOYMENT

PERSONAL INFORMATION

EMPLOYMENT DESIRED

Educational Background

Employment History

Employer #1

Employer #2

Employer #3

REFERENCES