San Diego Employment Application

Name*

First Last

Present Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Permanent Address (if different from present address)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Cell Phone*

Home Phone

Email*

Employment Desired

Position Applying for*

Are you applying for?*

Regular Full-time work
Regular Part-time work
Temporary work, e.g. summer or holiday work

What days and hours are you available to work? Please be specific*

If applying for temporary work, during what period of time will you be available?

Are you able to commit to a minimum of 2 year at this position?*

Yes
No

At Dragonfly Designs we invest heavily in our staff’s training & development and we are looking for long-term staff dedicated to our mission. We request a minimum of 2 years.

At Dragonfly Designs we invest in our staffs training & development and are looking for a long term commitment to this position. How long can you realistically commit to working with us?*

Are you available for work on weekends?*

Yes
No

Would you be available to work overtime, if necessary?*

Yes
No

If hired, on what date can you start work?

Salary desired*

Personal Information

Have you ever applied to or worked for Dragonfly Designs before?*

Yes
No

If yes, When?*

Do you have any friends or relatives working for Dragonfly Designs?*

Yes
No

If yes, state name(s) and relationship*

Why are you applying for work at Dragonfly Designs?*

If hired, would you have a reliable means of transportation to and from work?*

Yes
No

Do you own your own car?*

Yes
No

Are you at least 18 years old? (If under 18, hire is subject to verification that you are of minimum legal age.)*

Yes
No

If hired, can you present evidence of your U.S. citizenship or proof of your legal right to live and work in this country?*

Yes
No

Are you able to perform the essential functions of the job for which you are applying, either with or without reasonable accommodation?*

Yes
No

(Note: We comply with the ADA and consider reasonable accommodation measures that may be necessary for eligible applicants/employees to perform essential functions. Hire may be subject to passing a medical examination, and to skill and agility tests.)

If no, describe the functions that cannot be performed

Are you currently employed?*

Yes
No

If so, may we contact your current employer?*

Yes
No

Education, Training and Experience

High School Name

High School Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

No. of Years Completed

Did you graduate?

Yes
No

Degree or Diploma

College/University Name

College/University Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

No. of Years Completed

Did you graduate?

Yes
No

Degree or Diploma

Vocational/Business Name

Vocational/Business Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

No. of Years Completed

Did you graduate?

Yes
No

Degree or Diploma

Health Care Training Name

Health Care Training Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

No. of Years Completed

Did you graduate?

Yes
No

Degree or Diploma

Some of our customers (clients) may not speak English. Do you speak, write or understand any foreign languages?*

Yes
No

If yes, which languages(s)?

Do you have any other experience, training, qualifications, or skills that you feel make you especially suited for work at Dragonfly Designs?*

Yes
No

If so, please explain:

At Dragonfly Designs these are our Core Values: We provide a complete “WOW” experience. We are enthusiastic, energetic, tenacious, and prepared for the task at hand. We are interested in continuous self-improvement. We encourage individual initiative. We practice unequivocal excellence. We understand the value of reputation, and reputation outweighs profit every time. We treat everyone with respect, compassion and empathy. We encourage teamwork Please tell us how your contributions will be a good fit with our company culture:*

Employment History

List below all present and past employment starting with your most recent employer (last five years is sufficient). Account for all periods of unemployment. You must complete this section even if attaching a resume.

Name of Employer*

Type of Business*

Your Supervisor's Name*

First Last

Phone*

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Start Date*

End Date

Your Position and Duties*

Reason for Leaving

May we contact this employer for a reference?*

Yes
No

Name of Employer

Type of Business

Your Supervisor's Name

First Last

Phone

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Start Date

End Date

Reason for Leaving

Your Position and Duties

May we contact this employer for a reference?

Yes
No

Name of Employer

Type of Business

Your Supervisor's Name

First Last

Phone

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Start Date

End Date

Your Position and Duties

Reason for Leaving

May we contact this employer for a reference?

Yes
No

References

List below three persons not related to you who have knowledge of your work performance within the last three years.

Name*

First Last

Phone*

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Occupation*

No. of Years Acquainted*

Name

First Last

Phone

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Occupation

No. of Years Acquainted

Name

First Last

Phone

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Occupation

No. of Years Acquainted

Resume Upload

PLEASE READ CAREFULLY, INITIAL EACH PARAGRAPH AND SIGN BELOW

*

I hereby certify that I have not knowingly withheld any information that might adversely affect my chances for employment and that the answers given by me are true and correct to the best of my knowledge. I further certify that I, the undersigned applicant, have personally completed this application. I understand that any omission or misstatement of material fact on this application or on any document used to secure employment shall be grounds for rejection of this application or for immediate discharge if I am employed, regardless of the time elapsed before discovery.

*

I hereby authorize Dragonfly Designs to thoroughly investigate my references, work record, education and other matters related to my suitability for employment and, further, authorize the references I have listed to disclose to the Dragonfly Designs any and all letters, reports and other information related to my work records, without giving me prior notice of such disclosure. In addition, I hereby release the Dragonfly Designs, my former employers and all other persons, corporations, partnerships and associations from any and all claims, demands or liabilities arising out of or in any way related to such investigation or disclosure.

*

I understand that nothing contained in the application, or conveyed during any interview which may be granted or during my employment, if hired, is intended to create an employment contract between me and the Dragonfly Designs. In addition, I understand and agree that if I am employed, my employment is for no definite or determinable period and may be terminated at any time, with or without prior notice, at the option of either myself or the Dragonfly Designs, and that no promises or representations contrary to the foregoing are binding on the Dragonfly Designs unless made in writing and signed by me and the Dragonfly Designs 's designated representative.

*

Should a search of public records (including records documenting an arrest, indictment, conviction, civil judicial action, tax lien or outstanding judgment) be conducted by internal personnel employed by the Dragonfly Designs, I am entitled to copies of any such public records obtained by the Dragonfly Designs unless I mark the check box below. If I am not hired as a result of such information, I am entitled to a copy of any such records even though I have checked the box below.

Date

Applicant Digital Signature*

First Last

San Diego Employment Application