Position(s) Applying for
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Type work you are available for:
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Are you at least 18 years old?
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Date of Application
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MM
DD
YYYY
Full Name
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Please include Middle name
First Name
Last Name
Address
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Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Main Phone
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(###)
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Alternate Phone
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Email
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Name of Employer
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Supervisor
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May we contact?
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Address
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Phone
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(###)
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Job Title & Duties
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Reason for Leaving
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Name of Employer
Supervisor
May we contact?
Address
Phone
(###)
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Job Titles & Duties
Reason for Leaving
Name of Employer
Supervisor
May we contact?
Phone
(###)
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Job Title & Duties
Reason for Leaving
Have you ever been involuntarily terminated or asked to resign from any job?
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If yes, please explain:
Please explain any gaps in your employment history:
Please list any other experience, job related skills, additional languages, or other qualifications that you believe should be considered in evaluating your qualifications for employment:
School Name
Years Completed
Diploma
Specialized Training, Skills, or Extra Curricular Activities
School Name
Years Completed
Degree
Area of Study/Major
Specialized Training, Skills, or Extra Curricular Activities
School Name
Years Completed
Area of Major/Study
Degree
Specialized Training, Skills, or Extra Curricular Activities
School Name
Years Completed
Degree
Area of Study/Major
Other education information you'd like to include:
Name & Title
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Relationship
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Phone Number or Email
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Name & Title
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Relationship
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Phone Number or Email
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Name & Title
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Relationship
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Phone Number or Email
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Name & Title
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Relationship
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Phone Number or Email
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Name & Title
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Relationship
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Phone Number or Email
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Name & Title
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Relationship
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Phone Number or Email
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Have you ever used another name? If Yes, please specify:
On what date are you available to work?
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MM
DD
YYYY
If hired, would you be willing to work a modified work schedule?
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Monday
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Tuesday
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Wednesday
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Thursday
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Friday
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Saturday
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Sunday
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If hired, would you have a reliable means of transportation to and from work?
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Can you travel if the position requires it?
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If hired, are you able to present evidence of your identity and legal right to work in this country?
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Are you able to perform the essential job functions of the job for which you are applying?
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Have you ever been convicted of a misdemeanor or felony?
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If Yes, please give a date/explanation:
If hired, would you be willing to undergo a background check?
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Do you have a satisfactory driving record? (2 points or less)
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Are you able you lift a minimum of 70 pounds?
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Are you comfortable working on ladders/lifts?
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I hereby authorize the Company to thoroughly investigate my references, work record, education and other matters related to my suitability for employment and, further, authorize the prior employers and references I have listed to disclose to the Company any and all letters, reports and other information related to my work records, without giving me prior notice of such disclosure. In addition, I hereby release the Company, my former employers and all other persons, corporations, partnerships and associations from any and all claims, demands or liabilities arising out of or in any way related to such investigation or disclosure.
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In the event of my employment with the Company, I understand that I am required to comply with all rules and regulations of the Company.
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If hired, I understand and agree that my employment with the Company is at-will, and that neither I, nor the Company is required to continue the employment relationship for any specific term. I further understand that the Company or I may terminate the employment relationship at any time, with or without cause, and with or without notice. I understand that the at-will status of my employment cannot be amended, modified, or altered in any way by any oral modifications.
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I understand that safety of employees is extremely important to the Company and that the Company is committed to ensuring a safe working environment. I understand that I, and every employee, have a responsibility to prevent accidents and injuries by observing all safety procedures and guidelines and following the directions of my site supervisor. I understand and agree to comply with federal, state, and local regulations related to on-the-job safety and health.
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I hereby certify that the answers given by me are true and correct to the best of my knowledge. I further certify that I, the undersigned applicant, have personally completed this application. I understand that any omission or misstatement of material fact on this application or on any document used to secure employment shall be grounds for rejection of this application or for immediate discharge if I am employed, regardless of the time elapsed before discovery.
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I understand that if I am selected for hire, it will be necessary for me to provide satisfactory evidence of my 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.
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I understand that if any term, provision, or portion of this Agreement is declared void or unenforceable, it shall be severed and the remainder of this Agreement shall be enforceable.
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Signature
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Name
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Date
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MM
DD
YYYY
