Application Form

Step 1 of 4

25%

EMPLOYMENT APPLICATION

Equal access to programs, services and employment is available to all persons without regard to race, color, religion, creed, gender, national origin, age, disability, marital or veteran status, sexual orientation, or any other protected status. Those applicants requiring reasonable accommodation to the application and/or interview process should notify a representative of the Human Resources Department.

Position Applying For:(Required)

First Name:(Required)

Middle Name:

Last name:(Required)

Street Address:(Required)

Address Line 2:

City:

State / Province / Region:

ZIP / Postal Code:

Home Phone:(Required)

Alternate Phone:

Email:(Required)

Date(Required)

MM slash DD slash YYYY

Upload Your Resume

Drop files here or

Max. file size: 256 MB.

Are You Currently Employed?

Yes

Will You Work Overtime If Required?

Yes

Will You Work Weekends/Evenings if Required?

Yes

Are You Able To Travel if Work Requires it?

Yes

Have You Applied Here Before?

Yes

If Yes, Give Dates:

Do You Have Friends/Relative Working Here?

Yes

If Yes, State Name(s) and Relationship:

If Hired, Do You Have Adequate Transportation To and From Work?

Yes

If Hired, Can You Provide Proof of Eligibility to Work in the United States?

Yes

How Did You Hear About This Position?

Walk-in

Friend/Relative

Internet

Other

If Other Please Explain:

IF YOU ARE APPLYING FOR A POSITION WHERE DRIVING IS A REQUIREMENT, PLEASE ANSWER THE FOLLOWING QUESTIONS

Do You Have A Valid Driver's License?

Yes

License #:

Expiration Date:

Within the Past 3 Years, Have You Had Any Moving Violations and/or Traffic Accidents?

Yes

If Yes, Please Explain:

EDUCATION, TRAINING & EXPERIENCE

High School:

Years Completed:

Diploma

GED

None

College/University:

Years Completed:

Diploma, Course of Study, Major, Specialized Skills, ETC.:

Graduate/Professional:

Years Completed:

Diploma, Course of Study, Major, Specialized Skills, ETC.:

Trade/Business School:

Years Completed:

Diploma, Course of Study, Major, Specialized Skills, ETC.:

Other:

Years Completed:

Diploma, Course of Study, Major, Specialized Skills, ETC.:

Please summarize any actual experience, special training, skills, licenses and/or certificates you have which you feel are relevant to the position for which you are applying:

COMPUTER SKILLS: (PLEASE INCLUDE SOFTWARE TITLE AND YEARS OF EXPERIENCE)

Word Processing

Spreadsheet

Presentation

Internet

E-Mail

Other

List Any Additional Information You Would Like Us To Consider:

REFERENCES

List three (3) business/work references who have knowledge of your work performance and are not related to you and are not previous supervisors. If not applicable, list three school or personal references who are not related to you.

REFERENCE 1:

Name:

Title:

Telephone:

Years Known:

Relationship to You:

REFERENCE 2:

Name:

Title:

Telephone:

Years Known:

Relationship to You:

REFERENCE 3:

Name:

Title:

Telephone:

Years Known:

Relationship to You:

EMPLOYMENT HISTORY

If submitting a resume in lieu of completing this portion of the application, the resume MUST CONTAIN ALL OF THE FOLLOWING INFORMATION. If information is missing, your application may be rejected.
Starting with your most recent employer, please provide the following information.

My Employment History is in my Resume

Current or Last Employer:

Supervisor Name:

Supervisor Phone Number:

May We Contact?

Yes

Starting Position:

Start Date: (YR/MO)

Main Duties:

Final Position:

End Date: (YR/MO)

Reason for Leaving:

Employer:

Supervisor Name:

Supervisor Phone Number:

May We Contact?

Yes

Starting Position:

Start Date: (YR/MO)

Main Duties:

Final Position:

End Date: (YR/MO)

Reason for Leaving:

Please Explain Any Gaps In Your Employment History:

ACKNOWLEDGEMENT AND AUTHORIZATION

READ THOROUGHLY BEFORE SIGNING

Acknowledgement and Authorization

I certify that I have personally completed this employment application and all information I have provided in order to apply for and secure work with this employer is true, complete and correct. I further understand any false answers, statements or implications made by me in this application, in any interview, or other documents shall be considered sufficient cause for denial of employment or termination of employment if I should be employed by this employer.

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 and to otherwise verify the accuracy of 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 truthful and non-defamatory information, in a lawful manner, in the employment process and all other persons, corporations or organizations for furnishing such information about me.

If hired, I understand I am free to resign at any time, with or without cause and with or without prior notice, and the employer reserves the same right to terminate my employment at any time, with or without cause and with or 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 or definite duration. I understand that no supervisor or representative of the employer is authorized to make any assurance 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 understand the employer will conduct a pre-employment drug test to identify job applicants who may be using illegal drugs. I understand I have the right to refuse to undergo testing however my refusal to undergo testing will result in the termination of the pre-employment process. I further understand any applicant who fails a pre-employment drug test will not be hired.

I understand that should I receive a written Offer of Employment it will be contingent upon the successful completion of a post-employment physical paid for by the employer and conducted at a third party facility authorized by the employer. I understand I have the right to refuse to undergo testing however my refusal to undergo testing will result in the withdrawal of the Offer of Employment. I further understand any applicant who fails this test, as determined by the testing facility, will not be hired.

I understand that pursuant to all local, state and federal ordinances and/or laws, the employer will consider for employment qualified applicants with arrest and conviction records.

I understand that this employer does not unlawfully discriminate in employment and no question on this application is used for the purpose of limiting or eliminating any applicant from consideration for employment on any 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 for me to reapply and fill out a new application.

I understand and agree that the Company is under no obligation to consider or reconsider this application at any time and that acceptance of my application does not constitute an offer of employment

CAPTCHA