Employment Application

We consider applicants for all positions without regard to race, color, religion, creed, gender, national origin, age, disability, veteran status, or any other legally protected status.

"*" indicates required fields

Job Information

Position Applied For*

Date of Application*

Month

Day

Year

How Did You Learn About Us?*

Friend

Inquiry

Employment Agency

Relative

Other

Contact Information

Name*

First Middle Last

Address*

Street Address City State ZIP Code

Phone*

Email*

Social Security Number

(voluntary)

General Questions

Best Time To Contact You At Home*

If you are under 18 years of age, can you provide required proof of your eligibility to work?*

YES

Have you ever filed an application with us before?*

YES

If Yes, Give Date

Month

Day

Year

Have you ever been employed with us before?*

YES

If Yes, Give Date

Month

Day

Year

Do any of your friends or relatives, other than spouse, work here?*

YES

If Yes, state name, relationship and location

Are you currently employed?*

YES

May we contact your present employer?*

YES

Are you prevented from lawfully becoming employed in this country because of Visa or Immigration Status?

YES

Proof of citizenship or immigration status will be required upon employment.

Date available for work*

Month

Day

Year

What is your desired salary range?

Are you available to work*

Full-Time

Part-Time

Temporary

Intern

Work Schedule Options*

Please list your schedule availability or any restrictions that you may have.

Are you currently on "lay-off" status and subject to recall?*

Start with your present or last job. Include any job-related military service assignments and volunteer activities. You may exclude organizations that indicate race, creed, religion, gender, national origin, disabilities or other protected status.

Employer #1

Company Name

From

Month

Day

Year

Month

Day

Year

Company Name

Phone Number

Job Title

Supervisor

Reason for Leaving

Starting Hourly Rate

Please enter a number greater than or equal to 0.

Ending Hourly Rate

Please enter a number greater than or equal to 0.

Work Performed

Employer #2

Company Name

Month

Day

Year

From

Month

Day

Year

Phone Number

Job Title

Supervisor

Reason for Leaving

Starting Hourly Rate

Please enter a number greater than or equal to 0.

Ending Hourly Rate

Please enter a number greater than or equal to 0.

Work Performed

Employer #3

Company Name

From

Month

Day

Year

Month

Day

Year

Phone Number

Job Title

Supervisor

Reason for Leaving

Starting Hourly Rate

Please enter a number greater than or equal to 0.

Ending Hourly Rate

Please enter a number greater than or equal to 0.

Work Performed

Comments:

Include an explanation of any gaps in employment.

Describe any specialized training, apprenticeship, skills and extra-curricular activities.

Describe any job-related training received in the United States military.

List professional, trade, business or civic activities and offices held.

You may exclude membership which would reveal gender, race, religion, national origin, age, ancestry, disability, or other protected status·

Additional Information

Other Qualifications

Summarize special job-related skills and qualifications acquired from employment or other experience.

Specialized Skills

Skills / Equipment Operated

Skills

Terminal

Spreadsheet

PC/Mac

Word Processing

Typewriter

Shorthand

Words Per Minute

Please enter a number from 0 to 600.

Production / Mobile Machinery (list)

Other (list)

State any additional information you feel may be helpful to us in considering your application

Can you perform the essential functions of the job, for which you are applying, either with or without a reasonable accommodation?

YES

Do not answer this question unless you have been informed about the requirements of the job for which you are applying.

Personal / Professional References

Name

Phone

Best Time to Call

Occupation

Name

Phone

Best Time to Call

Occupation

Name

Phone

Best Time to Call

Occupation

Resume

Accepted file types: pdf, Max. file size: 10 MB.

If you wish to include a resume, please upload a PDF version.

Applicant's Statement

Declaration of Truthfullness of Answers*

I certify that the answers given herein are true and complete.

Authorization of Investigation*

I authorize the investigation of all statements contained in this application for employment as may be necessary in arriving at an employment decision.

This application for employment shall be considered active for a period of time not to exceed 45 days. Any applicant wishing to be considered for employment beyond this time period should inquire as to whether or not applications are being accepted at this time.

"At Will" Employment*

I hereby understand and acknowledge that, unless otherwise defined by applicable la, any employment relationship with this organization is of an "at will" nature, which means that the Employee may resign at any time and the Employer may discharge Employee at any time with or without cause. It is further understood that this "at will" employment relationship may not be changed by any written document or by conduct unless change is specifically acknowledged in writing by an authorized executive of this organization.

Right to Discharge*

In the event of employment, I understand that false or misleading information given in my application or interview(s) may result in a discharge. I understand, also, that I am required to abide by all rules and regulations of the employer.

This field is for validation purposes and should be left unchanged.

(936) 422-4195

Employment Application