Application Job ApplicationStandard Application for Employment It is our policy to comply with all applicable state and federal laws prohibiting discrimination in employment based on race, age, color, sex, religion, national origin, disability or other protected classifications. Please carefully read and answer all questions. You will not be considered for employment if you fail to completely answer all the questions on this application. You may send a resume, but all questions must be answered.Position applying for:Personal DataFirst NameLast NameEmailHome Phone NumberCell Phone NumberAddressAddress Line 1Address Line 2CityStateZip CodeDate you can start workSalary DesiredDo you have a High School Diploma or GED? Yes NoPosition Information Check all that you are willing to workHours Full Time Part Time Days Evenings Swing Graveyard WeekendsStatus: Regular TemporaryAre you authorized to work in the U.S. on an unrestricted basis? Yes NoHave you ever been convicted of a felony? (Convictions will not necessarily disqualify an applicant for employment) Yes NoIf yes, explain:Have you been told the essential functions of the job or have been viewed a copy of the job description listing the essential functions of the job? Yes NoCan you perform the essential functions of the job with or without reasonable accommodation? Yes NoQualifications Please list any education or training you feel relates to the position applied for that would help you perform the work, such as schools, colleges, degrees, vocational or technical programs, and military training. SchoolSchoolOtherSchool NameSchool 1School 2Other SchoolDegreeSchool 1 DegreeSchool 2 DegreeOther School DegreeAddress/City/StateSchool 1 AddressSchool 2 AddressOther School AddressSpecial Skills - List any special skills or experience that you feel would help you in the position that you are applying for (leadership, organizations/teams, etc.)References Please list three professional referecnes not related to you, with full name, address, phone number, and relationship. If you don't have three professional references, then list personal, unrelated references.NameReference Name 1Reference Name 2Reference Name 3Address/City/StateReferences Address 1References Address 2References Address 3PhoneReferences Phone 1References Phone 2References Phone 3RelationshipReferences Relationship 1References Relationship 2References Relationship 3Work History Start with your present or most recent employment and work back. Use separate sheet if necessary. (Include paid and unpaid positions)Job Title #1Company NameCityStart DateSupervisor's NameStateEnd DatePhone NumberZipDutiesReason for LeavingStarting SalaryEnding SalaryMay we contact your present employer? Yes No N/AJob Title #2Company NameCityStart DateSupervisor's NameStateEnd DatePhone NumberZipDutiesReason for LeavingStarting SalaryEnding SalaryJob Title #3Company NameCityStart DateSupervisor's NameStateEnd DatePhone NumberZipDutiesReason for LeavingStarting SalaryEnding SalaryJob Title #4Company NameCityStart DateSupervisor's NameStateEnd DatePhone NumberZipDutiesReason for LeavingStarting SalaryEnding SalaryTrue Application I certify that the facts set forth in this Application for Employment are true and complete to the best of my knowledge. I understand that if I am employed, flase statements, omissions or misrepresentations may resut in my dismissal. I authorize the Employer to make an investiagation of any of the facts set forth in this application and release the Employer from any liability. The employer may contact any listed references on this application.At will employer I acknowledge and understand that the company is an "at will" employer. Therefore, any employee (regular, temporary, or other type of category employee) may resign at any time, just as the employer may terminate the employment relationship with any employee at any time, with or without cause, with or without notice to the other party.Submit Application