Employment Opportunities At this time these are the current employment opportunities:
On-line Employment Application:
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.
Referral Source
Advertisement Current Employee Relative Employment Agency - Government Employment Agency - Private Search Engine Other
Name of source (if other)
Name
LAST FIRST MIDDLE
Address Social Security #
STREET CITY STATE ZIP
Telephone # E-mail Address
If necessary, best time to call you at home is
May we contact you at work? Yes No
If yes, work number and best time to call
If you are under 18 and it is required, can you furnish a work permit? ...Yes No
If no, please explain:
Have you submitted an application here before? .Yes No
If yes, give date(s) and position(s)
Have you ever been employed here before? .Yes No
If yes, give dates ..From To
Are you legally eligible for employment in this country? Yes No
Date available for work What is your desired salary range? .$
Type of employment desire: Full-Time Part-Time Temporary Seasonal Educational Co-Op
Will you relocate if job requires it? ..Yes No Will you travel if job requires it? . Yes No
Are you able to meet the attendance requirements of the position? Yes No
Will you work overtime if required? Yes No
If no, please explain
Have you ever been bonded? .Yes No
Have you ever pled guilty or no contest to, or been convicted of a crime? .. Yes No
If yes, please provide date(s) and details
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 APPLIED FOR WILL BE TAKEN INTO ACCOUNT.
Drivers license number if driving is an essential job function: State:
Employment History
Provide the following information of your past and current employers, assignments or volunteer activities, starting with the
most recent (use additional sheets if necessary). Explain any gaps in employment in comments section below.
Phone Number:
Address:
Starting Job Title:
Ending Job Title:
Reason for leaving:
Name of Supervisor:
May we contact them?: Yes No
Dates Employed:
From: to
Starting Salary:
per Hour Week Month
Ending Salary
Summarize type of work performed and job responsibilities:
Explain any gaps in employment:
Skills and Qualifications
Summarize any special training, licenses and/or certificates that may qualify you as being able to perform job-related functions in the position for which you are applying.
Educational Background
A. List last three (3) schools attended, starting with most recent. D. Grade point average or class rank.
B. List number of years completed. E. Major field of study.
C. Indicate degree or diploma earned, if any. F. Minor field of study (if applicable).
References
List name and telephone number of three business/work references who 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.
Additional Information
List professional, trade, business or civic associations and any offices held.
List special accomplishments, publications, awards, etc.
List any additional information you would like us to consider.
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 employers 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 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 such information in the employment process and all other person, 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 for 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 or 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 employers 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. YES