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APPLICATION FOR EMPLOYMENT
Equal access to programs, services and employment is available to all persons. Those applicants requiring reasonable accommodation to the application and/or interview process should notify a representative of the Human Resources Department.
 
Position        
How Do We Contact You?
Last Name First Name Middle Initial
Mailing Address
City State Zip Code
Social Security # Telephone Mobile/Other Phone
Email Address

Preferred Method of Contact: Phone Email

If you are under 18, and it is required, can you furnish a work permit? Yes No
If no, please explain
Have you ever been employed here before? Yes No
If yes, give dates and positions
Are you legally eligible for employment in this country? Yes No
Date available for work
Desired salary range   
Type of employment desired Full Time Part Time Temporary Seasonal Educational Co-Op
Are you able to meet the attendance requirements of the position? Yes No
Our training schedule is Monday - Friday from 8am to 5pm and will last 1-2 weeks.
Are you able to commit to this training schedule? Yes No
Have you ever pled "guilty" or "no contest" to, or been convicted of a crime? Yes No
Answering "yes" to these questions does not constitute an automatic bar to employment. Factors such as date of the offense, seriousness and nature of the violation, rehabilitation and position applies for will be taken into account.
Have you ever been convicted of a criminal offense? Yes No
If yes, please list charge(s)
Where Convicted                            Date            Status
Note: Omit minor vehicle violations and any offense committed before your 17th birthday, which is finally adjudicated in juvenile court or under a youthful offender law. Conviction of a criminal offense is not a bar to employment in all cases. Each conviction is evaluated individually.
Tell us about your education:

High School

# Years Completed

Did you Graduate? Yes No

Program

 

College

# Years Completed

 

Did you Graduate? Yes No

Major    

Degree  

Other

# Years Completed

Did you Graduate? Yes No

Program

 
Tell Us About Your Work Experience:
Describe your work experience in detail, beginning with your current or most recent job. Include military service (indicate rank) and job related volunteer work, if applicable. Provide an explanation for any gaps in employment. All information in this section must be complete.
Dates Employed To      Employer      Telephone
Address

Starting Job Title/ Final Job Title

Immediate supervisor and Title 
Summarize the nature of work performed and job responsibilities


Hourly Rate/Salary        Starting $ Per      Final  $ Per

Reason for Leaving May we contact for reference? Yes No
Dates Employed To      Employer      Telephone
Address

Starting Job Title/ Final Job Title

Immediate supervisor and Title 
Summarize the nature of work performed and job responsibilities


Hourly Rate/Salary        Starting $ Per      Final  $ Per

Reason for Leaving May we contact for reference? Yes No
Dates Employed To      Employer      Telephone
Address

Starting Job Title/ Final Job Title

Immediate supervisor and Title 
Summarize the nature of work performed and job responsibilities


Hourly Rate/Salary        Starting $ Per      Final  $ Per

Reason for Leaving May we contact for reference? Yes No
References
Name Telephone
# Years Known
Name Telephone
# Years Known
Name Telephone
# Years Known
Applicant Statement
I certify that all information I have provided in order to apply for and secure work with the employer is true, complete and correct.
I understand that any information provided by me that is found to be false, incomplete or misrepresented in any respect, will be sufficient cause to (i) cancel further consideration of this application, or (ii) immediately discharge me from the employer's service, whenever it is discovered.
I expressly authorize, without reservation, the employer, its representatives, employees or agents to contact and obtain information from all references (personal and professional), employers, public agencies, licensing authorities and educational institutions to otherwise verify the accuracy off all information provided by me in this application, resume or job interview. I hereby waive any and all rights and claims I may have regarding the employer, its agents, employees or representatives, for seeking, gathering and using such information in the employment process and all other persons, corporations or organizations for furnishing such information about me.
I understand that the employer does not unlawfully discriminate in employment and no question on this application is used for the purpose of limiting or excusing any applicant from consideration form employment on a basis prohibited by applicable local, state or federal law.
I understand that this application remains current for only 30 days. At the conclusion of that time, if I have not heard from the employer and still wish to be considered for employment, it will be necessary to reapply and fill out a new application.
If I am hired, I understand that I am free to resign at any time, with or without cause and without prior notice, and the employer reserves the same right to terminate my employment at any time, with or without cause and without prior notice, except as may be required by law. This application does not constitute an agreement or contract for employment for any specified period of definite duration. I understand that no supervisor or representative of the employer is authorized to make any assurances to the contrary and that no implied, oral or written agreements contrary to the foregoing express language are valid unless they are in writing and signed by the employer's president.
I also understand that if I am hired, I will be required to provide proof of identity and legal authority to work in the United States and that federal immigration laws require me to complete an I-9 Form in this regard.
I certify that I have read, fully understand and accept all terms of the foregoing Applicant Statement.
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