APPLICATION
FOR EMPLOYMENT
We consider applications for all positions without regard to race, color, religion, creed, sex, national origin, disability, sexual orientation, citizenship status or any other legally protected status.
 
 
 
 
 
 
Position(s) Applied For
2012-2-6
 
How Did You Learn About Us?
 
 
 
Are you 18 years old or older? ....................................................................................................
     
Have you ever filed an application with us before? ....................................................................
  If Yes, give date    
Have you ever been employed with us before? .......................................................................... Yes No
  If Yes, give date    
Do any of your friends or relatives work here? ...........................................................................
     
Are you currently employed? ......................................................................................................
       
  If Yes, may we contact your present employer? ...........................................................
     
Are you prevented from lawfully becoming employed in this country because of Visa or Immigration Status?    
  Proof of citizenship or immigration status will be required upon employment ...................
     
Date available for work : What is your salary requirement?    
Are you available to work:
(please indicate Shift )
             
  ( please indicate )
           
  ( please indicate dates available )
     
Can you travel if a job requires it? ............................................................................................. Yes No
Have you been convicted of a crime other than a minor    
traffic violation within the last seven years? ................................................................................ Yes No
A criminal record does not constitute an automatic bar to employment and will be considered only as it relates to the job in question  
Do you have a high school diploma or a GED?.......................................................................... Yes No
 
WE ARE AN EQUAL OPPORTUNITY EMPLOYER
 
 
EDUCATION
 
Name and Address
of School
Course of Study
Number of Years Completed
Diploma
Degree

College

Graduate
Professional

Technical/Trade

 
 Describe any specialized training, apprenticeship, skills and extracurricular activities.
 
Other Qualifications.
Summarize special job related skills and qualifications acquired from employment or other experience.
 
 
 EMPLOYMENT EXPERIENCE
 Start with your present or last job. Include any jobrelated military service assignments and volunteer activities. You may exclude organizations which indicate race, color, religion, gender, national origin, disabilities or other protected status.
 
1
Employer
Dates Employed 
From        To
Address
Telephone Number(s) Hourly Rates/Salary
Starting         Final
Job Title
Reason for Leaving  
Work Performed
   
2
Employer
Dates Employed 
From        To
Address
Telephone Number(s) Hourly Rates/Salary
Starting         Final
Job Title
Reason for Leaving  
Work Performed
   
3
Employer
Dates Employed 
From        To
Address
Telephone Number(s) Hourly Rates/Salary
Starting         Final
Job Title
Reason for Leaving  
Work Performed
   
4
Employer
Dates Employed 
From        To
Address
Telephone Number(s) Hourly Rates/Salary
Starting         Final
Job Title
Reason for Leaving  
Work Performed
 
 State any additional information you feel may be helpful to us in considering your application.
 
 Note to Applicants: DO NOT ANSWER THIS QUESTION UNLESS YOU HAVE BEEN INFORMED ABOUT THE REQUIREMENTS OF THE JOB FOR WHICH YOU ARE APPLYING.
 Can you perform the essential functions of the job, for which you are applying, either with or without a reasonable accommodation?
  Yes No  

 
 
 REFERENCE
Name    Area Code Phone N.
Address
 
Name    Area Code Phone N.
Address
 
Name    Area Code Phone N.
Address
 
 
 APPLICANT'S STATEMENT

I certify that answers given herein are true and complete.

I authorize 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 emplyment beyond this time period should inquire as to whether or not applications are being accepted at that time.

I hereby understand and acknowledge that, unless otherwise defined by applicable law, any employment relation ship with this organization is of an "at will" nature, which means that the Employee may resign at any time and the Employer may discharge an 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 such change is specifically acknowledged in writing by an authorized executive of this organization.

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