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Job Application

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Name
Enter full address including city, state, and ZIP.
Enter name and phone number of your emergency contact.
Enter full address including city, state, and ZIP.
Are you at least 18 years of age?
Can you produce documented proof of your identity and eligibility for employment in the United States?
Examples: Driver’s license, Social Security card, birth certificate, and/or immigration documents.
Type of Employment Desired
Include the range you plan to work as well, for example, from X AM to Y PM.
Please include the name and address of the school, courses majored in, and if graduated, what kind of degree.
Selected Value: 7
Slide to the last level of elementary/middle education completed.
Please include the name and address of the school, courses majored in, and if graduated, what kind of degree.
Selected Value: 9
Slide to the last level of high school completed.
Please include the name and address of the school, courses majored in, and if graduated, what kind of degree.
Selected Value: 1
Slide to the last year of college education completed.
Please include the name and address of the school, courses majored in, and if graduated, what kind of degree.
Have you applied for a job with us before?
Have you ever worked with us before?
How did you come to apply?
Have you ever been bonded?
Have you ever refused a bond?
Have you ever been convicted of a violation of the law except simple possession of marijuana or a minor traffic violation?
A conviction will not necessarily disqualify you from employment.
Have you ever been discharged or requested to resign from a position?
Are you employed now?
If yes, may we contact your present employer?
Have you ever held a position of trust (handling money or confidential material)?
Do you have any reason to believe that you would have difficulty meeting this company's work schedules?
Are you able to perform the essential functions of the position applied for, with or whithout reasonable accomodation?
Please provide the following information: name and address of most recent employer, their telephone number, intermediate supervisor (name and position), date hired, starting rate, job title & duties, date left, last rate, reason for leaving.
May we contact this employer?
Please provide the following information: name and address of most recent employer, their telephone number, intermediate supervisor (name and position), date hired, starting rate, job title & duties, date left, last rate, reason for leaving.
May we contact this employer?
Please provide the following information: name and address of most recent employer, their telephone number, intermediate supervisor (name and position), date hired, starting rate, job title & duties, date left, last rate, reason for leaving.
May we contact this employer?
Please list 3 references who aren’t related to you or former supervisors. Include their name, address, and telephone number.
“I certify that the information given by me in this application is true in all respects, and I agree that if the information given is found to be false in any way, it shall be considered sufficient cause for denial of employment or discharge. I authorize the use of any information in this application to verify my statements, and I authorize past employers, all references, and any other persons to answer all questions asked concerning my ability, character, reputation, and previous employment record. I release all such persons from any liability or damages on account of having furnished such information.” “I understand that nothing contained in this employment application or in the granting of an interview is intended to create an employment contract between the company and myself for either employment or for the providing of any benefit. No promises regarding employment have been made to me, and I understand that no such promise or guarantee is binding upon the company unless made in writing. If an employment relationship is established, I understand that I have the right to terminate my employment at any time and that the company retains the same right. “If I am offered employment, I agree to submit to a physical examination whenever requested, and I understand my becoming employed and/or my continued employment are subject to the results of any physical examination related to my job duties in accordance with company policies and procedures.” I understand that if employed, policies and rules which are issued are not conditions of employment and that the employer may revise policies or procedures in whole or in part, at any time.” “I understand that this application will be kept on active file for 60 days from the date completed, after which time I would have to reapply in accordance with established company procedures.”