Application for Employment
Complete all requested information. Any applicant who provides un-requested information will be automatically rejected from employment consideration. The BMK Designs is an Equal Opportunity Employer and will not discriminate, or tolerate discrimination, against any employee or applicant in any manner prohibited by law.

PERSONAL INFORMATION

Today's Date    SS#               
Last Name       First Name       
Street Address City, State, Zip
Telephone        Eligible to work in the U.S.?  Yes No
Have you ever worked for us under a previous name?  Yes  No
If yes, please provide full name:
Referred by:  
If related to anyone in our employ, name & department:
Are you legally eligible for employment? (If hired, you will be required to submit proof of employment eligibility)  Yes  No
Are you of legal age to work?  Yes  No


EMPLOYMENT DESIRED

Position Date Available
Salary Desired
Currently employed?  Yes No   
 If yes, may we contact your present employer? Yes No
Have you worked for the BMK Designs before? Yes No  
If yes, in what department?  
Dates of Employment:       

EDUCATION

High School Year Completed Course of Study 
College       Year Completed Degree/Specialty
Other          Year Completed Degree/Specialty
Licensed or Registered? Yes No
Type:          Number:

Memberships in job-related professional organizations?

Do you have a record of founded child or dependent adult abuse, or have you ever been convicted of a crime in this state or any other state? Yes No   If yes, please explain:

(Conviction will not automatically disqualify an applicant from employment consideration)

Have you ever been sanctioned under the Social Security Act and listed on the Office of Inspector General's list of excluded individuals/entities?  Yes  No   If yes, please explain:

EMPLOYMENT HISTORY

Present and former employers listed will be contacted as references if you are a finalist for a position. If you do not have a history of at least three employers, please provide the names, addresses, and telephone numbers of other references who are not related to you.

1
Employer  Position Held
Address   Immediate Supervisor
Brief Description of Duties:
Dates of Employment:  to Salary (Start to Final) to
Reason for Leaving: 
Account for period between jobs:
2
Employer Position Held
Address   Immediate Supervisor
Brief Description of Duties:
Dates of Employment:  to Salary (Start to Final) to
Reason for Leaving: 
Account for period between jobs:
3
Employer Position Held
Address   Immediate Supervisor 
Brief Description of Duties:
Dates of Employment:  to Salary (Start to Final) to
Reason for Leaving: 
Account for period between jobs:

By signing below or submitting this form, I certify that the answers and information set out in this application for employment are true, accurate and complete to the best of my knowledge.  I acknowledge that if any answer or information is not true, accurate or complete, I may not be hired, or, if hired, I may be discharged.  I authorize the BMK Designs to investigate all statements contained in this application for employment and to investigate my character and qualifications.  I authorize my prior employers, references and others with information regarding my work or educational history, or my character, to provide the BMK Designs with all requested information and references, and to cooperate fully with the investigation of my character and qualifications.  I further release the BMK Designs, and any person or organization providing information to the BMK Designs regarding my work or educational history, character or qualifications from any liability for soliciting and securing, or for providing such information.

I understand that this application is not a contract of employment, and I acknowledge that no oral representations have been made as such.  I further understand that I will only be considered for employment opportunities at the BMK Designs for 90 days from the date of this application.  If hired, I understand that my employment relationship with the BMK Designs is terminable at-will, with or without cause, by either myself or the BMK Designs.

In compliance with the Americans with Disabilities Act, I understand that if hired, I will be required to complete an employee health screening medical history statement.  This statement is required of all employees of the BMK Designs.  Any medical information acquired will be preserved as confidential and kept in a file separate from my personnel file.  If hired, I understand that the job offer I receive will be "conditioned" upon my being able to perform the essential functions of the position with or without reasonable accommodation.

Applicant Signature: ___________________________________________________   Date: ______________________