An Equal Opportunity Employer We do not discriminate on the basis of race, religion, national origin, color, gender, age, veteran status or disability: It is our intention that all qualified applicants be given equal opportunity and that selection decisions are based on job-related factors. Personal Social Security No Date(Required) Name(Required) First Middle Last Present address(Required) Street Address Apt. City State / Province / Region ZIP / Postal Code Email(Required) Cell #(Required)Home#Position applied for(Required) Rate of pay expected $ per hour(Required) Availability(Required) Full time Part time Holidays Preferred Times(Required) List any friends or relatives working here(Required) If your application is considered favorably, on what date will you be available to work?(Required) Are there any other work experiences, skills, or qualifications that you feel would especially fit you for work here? Please add any additional comments you think are important for us to consider.(Required)If hired, can you provide proof you are eligible to work in the United States?(Required) Yes No Have you worked for a firm under a different name?(Required) Yes No If yes, give name Personal References (not former employers or relatives)(Required)Name and occupationAddressPhone number Add RemoveMembership in Professional or Civic Organizations (do not include racial, religious, or nationality groups)(Required)Name or description of organizationActive participation ( Please Add From-To)Offices held Add RemoveEducation record Name of School(Required) High School College/University Trade School, etc… Other List(Required)Degree awarded ( High School )Grade average ( High School )Honors ( High School ) Add RemoveListDegree awarded ( College/University)Grade average ( College/University)Honors ( College/University) Add RemoveListDegree awarded ( Trade School )Grade average ( Trade School )Honors ( Trade School ) Add RemoveListDegree awardedGrade averageHonors Add RemoveDo you type?(Required) Yes No WPM Office machines, computers and software you know how to operate.(Required) Work History #1 (begin with the most recent, list all past employers)(Required)Name of companyBusiness address, city, statePhone # Add RemoveWork History (begin with the most recent, list all past employers)(Required)Type of businessImmediate supervisorDate employed Add RemoveWork History (begin with the most recent, list all past employers)(Required)Exact job titleWages at Hire:Termination:Reason for termination/leaving Add RemoveWork History (begin with the most recent, list all past employers)(Required)Description of duties. Add RemoveMay we contact this employer?(Required) Yes No Are you eligible for rehire with this employer?(Required) Yes No Work History #2 (begin with the most recent, list all past employers)Name of companyBusiness address, city, statePhone # Add RemoveWork History (begin with the most recent, list all past employers)Type of businessImmediate supervisorDate employed Add RemoveWork History (begin with the most recent, list all past employers)Exact job titleWages at Hire:Termination:Reason for termination/leaving Add RemoveWork History (begin with the most recent, list all past employers)Description of duties. Add RemoveMay we contact this employer? Yes No Are you eligible for rehire with this employer? Yes No Work History #3 (begin with the most recent, list all past employers)Name of companyBusiness address, city, statePhone # Add RemoveWork History (begin with the most recent, list all past employers)Type of businessImmediate supervisorDate employed Add RemoveWork History (begin with the most recent, list all past employers)Exact job titleWages at Hire:Termination:Reason for termination/leaving Add RemoveWork History (begin with the most recent, list all past employers)Description of duties. Add RemoveMay we contact this employer? Yes No Are you eligible for rehire with this employer? Yes No Upload Resume/Cover Letter Drop files here or Select files Max. file size: 256 MB. AffidavitI certify that all information I have provided in this application is true and complete. I understand that any false information or omission may disqualify me from further consideration for employment and may result in my dismissal if discovered at a later date. I understand that the employer uses E-Verify, an internet-based system that compares information from my Form I-9, Employment Eligibility Verification, to records available to the U.S. Department of Homeland Security (DHS) and Social Security Administration (SSA) to confirm my identity and that I am authorized to work in the United States. I understand that the employer may request a background check, drug screen, and/or an investigative consumer report from a consumer reporting agency prior to and during my employment. These reports may include information as to my character, reputation, personal characteristics and mode of living obtained from neighbors, friends, former employees, schools and others. I understand that I have a right to make a written request within a reasonable time for the disclosure of the name and address of the consumer reporting agency so I may obtain a complete disclosure of the nature and scope of the investigation. I authorize the investigation of any or all statements contained in this application and also authorize any person, school, current employer (except as previously noted), past employers and organizations named in this application to provide relevant information and opinions that may be useful in making a hiring decision. I release such persons and organizations from any legal liability in making such statements. I understand that this application or subsequent employment does not create a contract of employment nor guarantee employment for any definite period of time. If employed, I understand that I have been hired at the will of the employer and my employment may be terminated at any time, with or without a cause and with or without a notice. I have read, understand, and by my signature consent to these statementsSignature(Required)Date(Required) MM slash DD slash YYYY
