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Company Applying For:
Your Name:
*
First Name
Last Name
Phone Number:
(###)
###
####
Email address:
*
Date:
MM
DD
YYYY
Address:
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
How long at present address?
Social Security Number:
What was your previous address?
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Have you ever been bonded?
Yes
No
If yes, with what employers?
State names of relatives and friends working for us other than your spouse:
Have you ever applied for employment with us?
Yes
No
If yes, what month, year, and location?
Position Desired:
If a driver's license is required for the position for which you are applying, do you have a valid drivers license?
Yes
No
If yes, please provide the following: License number, Expiration, and State.
Apart from absence for religious observance, are you available for full-time work?
Yes
No
If not, what hours can you work?
Will you work overtime if asked?
Yes
No
Will you be holding any other jobs while employed with us?
Yes
Now
If so, please describe:
Do you, the Applicant, have the necessary documentation to complete and I-9 form? (i.e.: US Passport, Alien Registration Receipt Card, Driver License, ID Card, SS Card or Birth Certificate)
Yes
No
When will you be available to begin work?
Other special training or skills (languages, machine operation, etc.):
How did you learn of our organization?
What is your highest level of education? What is the name and location of school? Course of study? Degree or Diploma?
Please list your relevant work experience starting with the most recent.. For each listing include: company name, address, name of supervisor, job title and describe your work, telephone, dates of employment, weekly pay, and reason for leaving:
If you served in the U.S. Armed Forces, please describe your duties and any special training, branch of service, dates of active duty, rank at discharge, and final discharge date:
We are an Equal Opportunity Employer. In compliance with Federal and State equal employment opportunity laws, qualified applicants are considered for all positions without regard to race, color, religion, sex, national origin, age, marital status, or the presence of a non-job related medical condition or handicap.I understand that this application will be given every consideration, but is not a promise of employment.I understand that there is a waiting period of sixty (60) days prior to being considered for any benefits offered by the above named Company. I further understand I shall have the right to terminate my employment at any time, with or without notice, and the above named Company has the same right, with or without notice. No one other than the President of the above named Company has the authority to modify this relationship or to make any agreement to the contrary. Any such modification or agreement must be in writing.I understand that the above named Company reserves the right to require me to submit to a test for the presence of drugs and/or alcohol in my system prior to employment and at any time during my employment. My employment may be contingent upon the passing of a physical examination and a test for the presence of drugs and/or alcohol in my system performed by a doctor selected by the above named Company. I consent to the disclosure of the results of the physical examinations and related tests to the above named Company.I understand that the above named Company may investigate my driving record and that an investigative consumer report may be prepared whereby information is obtained through personal interviews with my neighbors, friends and others with whom I am acquainted. This inquiry includes information as to my character, general reputation, personal characteristics and mode of living. I understand that I have the right to require a written request within a reasonable period of time to receive additional detailed information about the nature and scope of the investigation. I understand that the above named Company may contact my previous employers and I authorize those employers to disclose to the above named Company all records pertinent to my employment with them. In addition to authorizing the release of any information regarding my employment, I hereby fully waive any related rights or claims I have or may have against my former employers, their agents, employees, and representatives, as well as other individuals who release information to the above named Company, and release them from any and all liability or claims of damages that may directly or indirectly result from the use, disclosure, or release of any such information by any person or party, whether such information is favorable or unfavorable to me. I hereby state that all of the information that I provide on this application and in any interview is true and accurate. I understand that if I am employed and any such information is later found to be false in respect, I may be dismissed.
Signature of Applicant - by typing your name you are giving your electronic signature. Please include the date.
Thank you!
