Employment Application

Personal Information

Position(s) Being Applied For*

Name*

NOTE: You MUST use your legal name that appears on your divers license or social security card.

First Middle Last

Address*

Street Address Address Line 2 City State ZIP Code

Email*

Phone*

Last 4 Digits of SSN

Are you at least 16 years of age?*

Yes
No

Are you currently employed?*

Yes
No

Are you currently on lay-off and subject to recall?*

Yes
No

I am a United States Citizen or otherwise authorized to work in the United States on an unrestricted basis?*

Yes
No

Whom may we thank for your employment referral?

Do you have any friends or relatives working here?*

Yes
No

If yes, who?

Date available for work?*

Desired wage?

I am available to work (check all that apply)*

Select All
Full-time
Part-time
1st shift
2nd shift
3rd shift
Swing shift
Seasonal

Days you are available to work (check all that apply)*

Are there any dates/times you are unable to work?*

Yes
No

If yes, please explain

Have you ever been charged with a crime?*

Yes
No

If yes, please explain

Education

High School attended*

Location*

College/Trade School attended*

Location*

Did you receive a degree or certificate?*

Yes
No

If yes, what type of degree or certificate?

Summarize special job-related skills and qualifications acquired from employment or other experience.

Work Experience

Start with your most recent employer

Employer #1

Employer

Address

Street Address Address Line 2 City State ZIP Code

Phone

Supervisor

Job title

Reason for leaving

Date Employed (Started)

Date Employed (Left)

Pay Rate (Start)

Pay Rate (End)

Employer #2

Employer

Address

Street Address Address Line 2 City State ZIP Code

Phone

Supervisor

Job title

Reason for leaving

Date Employed (Started)

Date Employed (Left)

Pay Rate (Start)

Pay Rate (End)

Personal References

Please list two individuals, not related to you, whom you have known for at least one year.

Name*

Phone*

Years known

Name*

Phone*

Years known

Desired Platform for Virtual Interview

Interviews will be conducted via Zoom, Facetime or Skype. Please select your preference below.

Desired Platform*

Zoom
FaceTime
Skype

EEOC Statement

We consider applicants for all positions without regard to race, color, religion, creed, gender, national origin, age, marital or veteran status, disability or any other legally protected status.

EEOC Statement

Applicant's Statement

I certify that the facts contained in this application are true and complete to the best of my knowledge and understand that, if employed, falsified statements on this application shall be considered sufficient cause for my dismissal.

I authorize investigation of all statements contained in this application for employment as may be necessary in arriving at an employment decision. I release the listed references and all employers to provide you with any and all applicable information they may have.

This application for employment shall be considered active for a period of time not to exceed 45 days.

I understand and agree that, if hired, my employment is AT-WILL. THIS MEANS THAT, IF HIRED, EITHER THE COMPANY OR I CAN END THE EMPLOYMENT RELATIONSHIP AT ANY TIME AND FOR ANY OR NO REASON.

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.

I certify that the facts contained in this application are true and complete to the best of my knowledge and understand that, if employed, falsified statements on this application shall be considered sufficient cause for my dismissal.

I authorize investigation of all statements contained in this application for employment as may be necessary in arriving at an employment decision. I release the listed references and all employers to provide you with any and all applicable information they may have.

This application for employment shall be considered active for a period of time not to exceed 45 days.

I understand and agree that, if hired, my employment is AT-WILL. THIS MEANS THAT, IF HIRED, EITHER THE COMPANY OR I CAN END THE EMPLOYMENT RELATIONSHIP AT ANY TIME AND FOR ANY OR NO REASON.

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

Date

Name

This field is for validation purposes and should be left unchanged.

Personal Information

Education

Work Experience

Employer #1

Employer #2

Personal References

Desired Platform for Virtual Interview

EEOC Statement

Applicant's Statement

Contact

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