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Employment Application

This application form is intended for use in evaluating your qualifications for employment. This is not an employment contract. Please answer all appropriate questions completely and accurately. All qualified applicants will receive consideration without discrimination based on race, color, religion, national origin, age, sex, veteran status, disability, or any other basis prohibited by federal, state or local law. In accordance with requirements of the Americans With Disabilities Act, it is our policy to provide reasonable accommodation upon request during the application process to eligible applicants in order that they may be given a full and fair opportunity to be considered for employment. As an Equal Opportunity Employer, we intend to comply fully with applicable federal and state employment laws and the information requested on this application will only be used for purposes consistent with those laws.

    Contact Information

    Full Name:

    Are you 18 years old or older?

    Are you authorized to work in the U.S.?

    Note: The Federal Immigration and Reform and Control Act of 1986 requires that an Employment Eligibility Verification “Form I-9” be completed for every new hire and that within 3 business days of beginning work every new hire must present to the employer documentation establishing his/her identity and authorization to work. This federal requirement must be satisfied as a condition of employment.

    Present Address:

    City:

    State:

    Zip:

     

    Telephone Number:

    Alternate/Cell Phone Number:

    Email:

    Employment Information

    Position Applying For:

    Pay Expected:

    Date Available to Start:

    Availability (Check all that Apply):

    Full-TimePart-TimeTemporary1st Shift2nd Shift3rd ShiftOvertime

    How did you hear about our company?

    Have you ever applied or been employed with us before?

    If yes, when?

    If yes, where?

    Education:

    High School Name:

    Location:

    Graduated?

    Diploma?

    College or University Name:

    Location:

    Course of Study:

    Graduated?

    Degree?

    Technical/Trade School Name:

    Location:

    Course of Study:

    Graduated?

    Degree?

    Licenses, Certifications, Other Skills/Training:

    Location:

    Course of Study:

    Graduated?

    Degree?

    Employment History

    Please tell us about your employment history and experience. Begin with your most recent employer. Please include the past five (5) years including any periods of unemployment.

    Employer 1:

    Type of Business:

    Address:

    City:

    State:

    Zip:

    Position:

    Start Date:

    End Date:

    Job Duties:

    Wages:

    Supervisor:

    May we contact?

    Employer 2:

    Type of Business:

    Address:

    City:

    State:

    Zip:

    Position:

    Start Date:

    End Date:

    Job Duties:

    Wages:

    Supervisor:

    May we contact?

    Employer 3:

    Type of Business:

    Address:

    City:

    State:

    Zip:

    Position:

    Start Date:

    End Date:

    Job Duties:

    Wages:

    Supervisor:

    May we contact?

    References:

    Reference 1 Name:

    Phone/Address:

    Position:

    Years Known:

     

    Reference 2 Name:

    Phone/Address:

    Position:

    Years Known:

     

    Reference 3 Name:

    Phone/Address:

    Position:

    Years Known:

    I certify that the answers provided are true and complete to the best of my knowledge. I understand that any misrepresentations, omissions of facts or incomplete answers in any application document will disqualify me from further consideration for employment. I further understand that, if employed, any misrepresentations or omissions of facts in any application document will be cause for my dismissal at any time without prior notice. I authorize the company and/or its agents to verify any of this information.

    Depending on the position for which I am being considered, I understand that I may be required to take job-related tests. In addition, I understand that a post-offer drug test may be required for employment consideration. Depending on the position for which I am applying, I understand that a post-offer physical may also be required. I understand that a baseline audiometric test to determine my hearing ability may be performed.

    I authorize any person, organization, school, or business listed on this application to provide any and all information with regard to my past or current association and release said entity from any and all liability for disclosing information about me.

    I understand that this application is considered current for sixty (60) days and if after that time I am still interested in employment, it will be necessary for me to reapply.

    I understand that if employed by this company, I will abide by its rules and regulations which I understand are subject to change. I further understand that, if hired, my employment is for no definite period of time and may be terminated by either party at any time. I understand that this application represents no contractual agreement of any type.

    I acknowledge that I have read and understand the above statements.

    Name in Full (Electronic Signature):

    Today's Date: