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It is the policy of the Company to provide equal opportunity with regard to all terms and conditions of employment. The Company complies with federal and state laws prohibiting discrimination on the basis of race, color, religion, sex, national origin, disability, veteran status, age or any other protected characteristic.

First name:
Last name:
Address:
City:
State:
Zip:
Phone number (Home):
Phone number (Cell):
Social Security number:
Position applying for:
Shift Preferred
   
Special training or skills (languages, machine operation, types and brand of machine, etc.)
that would benefit you in the job for which you are applying:
 
   
Would you accept full-time work?
Yes No
Would you accept part-time work?
Yes No
What date would you be available for work?
Have you ever been employed here?
Yes No
If yes, dates:  
Are you legally eligible for employment in the United States?
If yes, proof is required if hired.
Yes No
If you are under 18 years old, can you provide a work permit if required?
Yes No

The following question is not designed to elicit information about an applicant’s disability. Please do not provide information about the existence of a disability, particular accommodation, or whether accommodation is necessary. These issues may be addressed at a later stage to the extent permitted by law.

Are you able to perform the essential functions for which you are applying
(with or without reasonable accommodation)?

  Yes
  No
  Need more information about the job’s essential functions to respond


Answering “yes” to the following question 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. Note: You are not obligated to disclose sealed or expunged records of conviction or attest or expunged juvenile records of conviction or arrest.

Have you ever pleaded “guilty” or “no contest” to, or been convicted of, a felony?

  Yes
  No
   
If yes, please provide date(s) and details


Education Background
 
High School
 
  Location:
  Did you graduate?
Yes No
  Degree or Diploma:

 
College
 
  Location:
  Did you graduate?
Yes No
  Degree or Diploma:

 
Graduate School
 
  Location:
  Did you graduate?
Yes No
  Degree or Diploma:
 
Vocational Training/ Other
  Location:
  Did you graduate?
Yes No
  Degree or Diploma or Certification:
  Additional information:
     
  Continuing Education:


Employee Experience

Please type “DO NOT CONTACT” next to the company name if you do not want us to contact.
List your most recent employer first:


  Employer:
  Contact name / supervisor:
  Address:
  Job Title:
  Dates employed:
  Hourly rate/Salary:
  Reason for Leaving:
  Additional information (such as equipment used, job description, etc.):

  Employer:
  Contact name / supervisor:
  Address:
  Job Title:
  Dates employed:
  Hourly rate/Salary:
  Reason for Leaving:
  Additional information (such as equipment used, job description, etc.):

  Employer:
  Contact name / supervisor:
  Address:
  Job Title:
  Dates employed:
  Hourly rate/Salary:
  Reason for Leaving:
  Additional information (such as equipment used, job description, etc.):

  May we contact your previous/ current employer?
Yes No


How did you learn about this company and position?

  Job advertisement (Identify publication or other media):
  Employee referral (Identify employee):
  Other (Specify if agency, job fair, college recruitment office, etc.):


Anti-Discrimination Clause

This company does not tolerate unlawful discrimination or harassment based on sex, race, color, religion, national origin, citizenship, age, disability, or other protected status under applicable federal, state or local law. No question on this application is used to limit or exclude an applicant from employment consideration. This Company takes all harassment complaints seriously and investigates each one promptly and thoroughly.

Applicant Statement

I certify that all the information submitted by me on this application is true and complete, and I understand that if any false or misleading information, omissions or misrepresentations are discovered, my application may be rejected, and is I am employed, my employment may be terminated at any time.

If hired, I agree to conform to the Company’s rules and regulations, and I understand that these rules and/or the employee handbook do not form a contract of employment either expressed or implied, and I agree that my employment and compensation can be terminated, with or without cause and with or without notice, at any time, at either my or the Company’s option.

I also understand and agree that the terms and conditions of my employment may be changed, with or without cause and with or without notice, at any time by the Company. I understand that no Company representative, other than its president, and then only when in writing and signed by the president has any authority to enter into any agreement for employment for any specific period of time, or to make any agreement contrary to the forgoing.

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 herby waive any and all rights and claims I may have regarding the employer, its agents, employees or representatives regarding for seeking, gathering and using truthful and nondefamatory information, in a lawful manner, in the employment process and all other persons, corporations or organizations for furnishing such information about me.

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.

By clicking “Submit” you agree that you have read all statements and that all information submitted is true.