Application For Employment
Goken America is an equal opportunity employer.  All applicants are considered without regard to race, color, ethnic or national origin, religion, age, sex, disability, citizenship or any other status protected by applicable federal, state or local law.

Instructions:  Complete all information.  You may be asked to provide additional information before this application can be processed.  Be sure to sign and date the application.  Please Print.

Name:

            

First:

Middle:

Last:

  
             

Social Security Number:

 

 

Phone:

  
           
             

Address:

  
             

City:

State:

Zip:

  
             

Position Desired:

          
       
             

Date Available to Begin:

  

Number of Hours Available to Work:

 
       
             

1. Are you willing to work overtime if needed: 

Yes No      

2. Are you willing to travel overnight:

 Yes No    

3. Are you willing to relocate, if necessary:

 Yes No      
             

Desired Salary or Pay Rate:

          
  4. Are you a U.S. Citizen or, if not, will you be able to provide, if hired, proof of authorization to work in the U.S.:  
      Yes

No

      

Education Background:

          

School

Name and Location

Course of Study

Number of Years Attended

Degree Attained

High School

College

Business / Trade / Technical

Graduate School

Other
 
             

5. Other Special Training or Skills (including foreign languages):


Employment History:

          

1.

          

Company Name:
 

  Phone:

 

 Employed (State month and year)  

Address:
 

  From:  

Name of Supervisor:

   To:      
               

State Job Title and Describe Your Work:

 
 		   Weekly Pay  
Start:

Reason For Leaving:

  

End:

 

  
   

2.

              

Company Name:
 

Phone:

   Employed (State month and year)  

Address:
 

   From:  

Name of Supervisor:

   To:  
               

State Job Title and describe Your Work:
 		   Weekly Pay  

Start:

Reason For Leaving:

   End:  
   

3.

              

Company Name:
 

Phone:

   Employed (State month and year)  

Address:
 

   From:  

Name of Supervisor:

   To:  

State Job Title and describe Your Work:

 
 		      
Weekly Pay

Reason For Leaving:

 

   Start:  
End:
   

5. Have you ever been terminated from a position: 

Yes

No
 

        
 

If yes, please explain:

    


References (Please exclude family members and include at least one employment-related reference):

        

Name

Phone

Years Known

Relationship

1.

2.

3.
 
 
               

6. Have you ever been convicted of or pleaded guilty to a crime other than a minor traffic violation (A “yes” answer is not automatic grounds for rejection):
 

Yes

No    

If yes, please explain:
 		      

7. Are you at least eighteen (18) years of age or older:

 Yes No        
               

STATEMENT OF APPLICANT
I certify that the information which I have provided herein is true, accurate and complete.  If any of the information provided is found to be untrue, incomplete or misrepresented, I understand that further consideration of this application may be canceled, or, if I have been hired, Goken America may immediately discharge me, whenever such untruth, incompletion or inaccuracy is discovered.

 I expressly authorized Goken America to investigate any of the information provided on this application and I release from any liability all companies, corporations, and individuals supplying such information.  I also give permission to Goken America to contact the references I have listed.

In the event that I am hired, I understand that such employment will be on an “at will” basis and that I may resign from my employment at any time, with or without cause, and without prior notice, and that Goken America retains the same rights to terminate my employment at any time, with or without cause, and without prior notice.  I understand that this application does not constitute a contract or agreement that I will be employed.  I further understand that no representative of Goken America is authorized to make any assurances to the contrary and no implied, oral or written agreement contradicting the foregoing is valid, unless expressly authorized in writing by the President of Goken America.

If employed, I hereby authorize deductions from wages due me for any amount I owe to the employer or for charges I have incurred; including, but not limited to, unreturned employer property, telephone calls and damages to property or equipment.

DO NOT SIGN THIS APPLICATION UNTIL YOU HAVE READ AND UNDERSTOOD THE TERMS OF THE STATEMENT OF APPLICANT.

  
               
 

Applicant's Signature:

Date:

  
 

Witness:

Date: