Employment Application

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PERSONAL INFORMATION

Name

First

Last

Address

Address Line 1

Address Line 2

City

State

Zip Code

Phone

Please give us the best phone to reach you from 8am - 4pm

REFERRER

Name of person who referred you

How did you hear of this position?

please select the place you first heard of this position

Other

Please tell us where you heard of this position if not listed above.

GENERAL QUESTIONS

Are you legally eligible for employment in the US?

Are you 18 years or older?

Are you currrently bound by an Employment or Non-Compete Agreement?

If yes, please explain

Have you ever been convicted of a felony?

A criminal record does not constitute an automatic disqualification to employment and will be considered only as it substantially relates to the job of interest.

Have you worked with us previously?

If so, when?

POSITION OF INTEREST

Please select a position from the Salaried OR Hourly list.

Salaried Position/Select a Department

Hourly Position/Select a Department

If position not seen in lists, please supply here

What is your preferred shift?

1st Shift 6:00am - 4:30pm, Mon-Thurs (possible OT Fridays)
2nd Shift 5pm - 5:30am, Sun-Tues (possible OT Wednesdays)

Expected Rate of Pay

Please indicate "per hour," "per month," or "per year"

Available Start Date

EMPLOYMENT HISTORY

List present/most recent position first, attach resume or list additional items at end of form.

Most Recent Employer

Current/most recent employer (Company Name)

Company phone

Format: (000) 000-0000

Company Address

Address Line 1

Address Line 2

City

State

Zip Code

Supervisor's Name / Direct Phone

Your position and duties

Start Date

(choose month and year if exact date not known)

End Date

(choose month and year if exact date not known)

Rate of Pay

(Please provide your last rate of pay)

May we contact this supervisor for reference?

If no, please explain

Reason for leaving

Please explain

Second Employer

Company 2 (Company Name)

Company 2 phone

Format: (000) 000-0000

Company 2 Address

Address Line 1

Address Line 2

City

State

Zip Code

Supervisor's Name 2 / Direct Phone

Your position and duties 2

Start Date 2

(choose month and year if exact date not known)

End Date 2

(choose month and year if exact date not known)

Rate of Pay

(Please provide your last rate of pay)

May we contact supervisor 2 for reference?

If no, please explain 2

Reason for Leaving 2

Please explain.

Third Employer

Company 3 (Company Name)

Company 3 phone

Format: (000) 000-0000

Company 3 Address

Address Line 1

Address Line 2

City

State

Zip Code

Supervisor's Name 3 / Direct Phone

Your position and duties 3

Start Date 3

(choose month and year if exact date not known)

End Date 3

(choose month and year if exact date not known)

Rate of Pay 3

(Please provide your last rate of pay)

May we contact supervisor 3 for reference?

If no, please explain 3

Reason for Leaving 3

Please explain.

EDUCATION

High School

High School Name

High School Address

Address Line 1

Address Line 2

City

State

Zip Code

High School Start Date

(choose month and year if exact date not known)

High School End Date

(choose month and year if exact date not known)

Did you graduate?

Course of Study

College or Trade School

College or Trade School Name

Write "none" if you did not attend.

School Address

Address Line 1

Address Line 2

City

State

Zip Code

College/Trade School Start Date

(choose month and year if exact date not known)

College/Trade School End Date

(choose month and year if exact date not known)

Did you graduate from College or Trade School?

Course of Study at College or Trade School

MILITARY SERVICE

Branch

Write "none" if not applicable.

Service Start Date

(choose month and year if exact date not known)

Service End Date

(choose month and year if exact date not known)

Rank at Discharge / Type of DIscharge

REFERENCES

Please provide 3 professional references (no relatives)

Name (first reference)

First

Last

First Reference Company Name

First Reference Phone

First Reference Email

Name (second reference)

First

Last

Second Reference Company Name

Second Reference Phone

Second Reference Email

Name (third reference)

First

Last

Third Reference Company Name

Third Reference Phone

Third Reference Email

ADDITIONAL SKILLS OR QUALIFICATIONS

Add more information

List other skills, schools, training or certifications that are relevant to your desired position.

DISCLAIMER AND SIGNATURE

Date

Name

By signing my name above I certify that all the information submitted by me on this application is true and complete. I also understand that if any false information, omissions, or misrepresentations are discovered, my application may be rejected and if I’m employed, my employment may be terminated at any time. I hereby authorize you to contact my references, employers (unless otherwise indicated), and education institutions to inquire about information that may be relevant to my employment application. I understand that no company representative, other than the president, has the authority to enter into or make employment agreements/contracts. I have read and understand these statements.

Please fill application completely. Applications without full history and references will be discarded.

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