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Applicant Instructions

Incomplete applications will not be processed.



Please note. This application is intended for use in evaluating your qualifications for employment. This is not an employment contract. Please answer all questions completely and accurately. False or misleading statements on this form are grounds for terminating the application process, or, if discovered after employment, terminating employment. Additional testing of job-related skills, background checks or for the presence of illegal drugs in your body may be required prior to employment.
 
PERSONAL INFORMATION
Name (Last, First, MI)*
Street Address*
City, State, Zip*
Home Telephone
Work Phone Number
Facsimile Number
Email Address*
Social Security Number*
Driver's License number/State/Expiration
 
EMPLOYMENT DESIRED
Position Applied For*
Desired Salary
How did you hear about this position?
What date are you available to start?
Desired Hours (full time, part time, etc.)
Have you ever been employed with this company before?
If Yes, when?
 
EDUCATION INFORMATION
Name and Address of High School*
Recieve High School Diploma?
Name and Address of Undergraduate College
How many years of Undergraduate College have you completed?
What is/was your course study?
What was your graduation date/projected graduation date?
Name and Address of Graduate/Professional School
How many years of Graduate College hove you completed?
What is/was your course study?
What was your graduation date/projected graduation date?
Other (Specify)
List any seminars, classes or other education not listed above which may help qualify you for this position:
 
EDUCATION INFORMATION
List below all present and past employers over the past five years, starting with your most recent employer. Account for all periods of unemployment. You must complete this section even if attaching a resume
1. Employer*
Address
City, State, Zip
Phone
Fax Number
Job Title
Supervisor
E-mail address of supervisor
Start Date
End Date
Starting Salary/Hourly Wage
Ending Salary/Hourly Wage
Reason for Leaving
What value did you add to this company or its customers?
2. Employer
Address
City, State, Zip
Phone
Fax Number
Job Title
Supervisor
E-mail address of supervisor
Start Date
End Date
Starting Salary/Hourly Wage
Ending Salary/Hourly Wage
Reason for Leaving
What value did you add to this company or its customers?
3. Employer
Address
City, State, Zip
Phone
Fax Number
Job Title
Supervisor
E-mail address of supervisor
Start Date
End Date
Starting Salary/Hourly Wage
Ending Salary/Hourly Wage
Reason for Leaving
What value did you add to this company or its customers?
4. Employer
Address
City, State, Zip
Phone
Fax Number
Job Title
Supervisor
E-mail address of supervisor
Start Date
End Date
Starting Salary/Hourly Wage
Ending Salary/Hourly Wage
Reason for Leaving
What value did you add to this company or its customers?
5. Employer
Address
City, State, Zip
Phone
Fax Number
Job Title
Supervisor
E-mail address of supervisor
Start Date
End Date
Starting Salary/Hourly Wage
Ending Salary/Hourly Wage
Reason for Leaving
What value did you add to this company or its customers?
 
ADDITIONAL INFORMATION
List any professional, trade, business or civic activities and office held. You may exclude membership that would reveal gender, race, religion, national origin, ancestry, age, disability or any other protected status
Have you ever been convicted of a felony or misdomeanor?*
If Yes, please explain:
 
JOB RELATED SKILLS
List any languages other than English that you speak, read or write fluently, good or fair:
Identify any job training that relates to this position:
Identify what skills you possess that make you the most qualified for this position:
Explain how you plan to add value to this company:
Describe what you believe are the most unique features of this company:
 
SKILLS AND QUALIFICATIONS INFORMATION
Have you ever been employed with this company before?
If Yes, when?
Do you have any friends or relatives employed by this company?
If Yes, please provide their names and relationship to you:
Are you currently employed?
May we contact your employer?
Are you currently on "lay off" status and subject to recall?
If you are under 18 years of age, can you provide proof of your eligibility to work?
If hired, can you provide proof of U.S. citizenship or proof of your legal right to work in the U.S.?
Are you able to perform all of the essential functions of the job for which you are applying with or without reasonable accomodation?
If hired, are there any accommodations the company would need to provide so that you can perform all those essential functions and duties of the position being applied for?
If Yes, please explain:
Hav you in the last 7 years been convicted of Driving Under the Influence ("DUI")?
If hired, would you have a reliable means of transporation to and from work?
If hired, would you be ablt to travel and work overtime as needed?
Have you ever been convicted of a felony or misdemeanor?
If Yes, please explain:
 
REFERENCES
List below three persons not related to you who have knowledge of your work performance within the last 5 years.
  Name, Address, E-mail: # Years Known Occupation and Address Relationship Telephone
1.
2.
3.
 
ADDITIONAL SPACE
Additional space provided to expand on any points or questions asked previously in this application:
 
EQUAL EMPLOYMENT OPPORTUNITY STATEMENT
Please read the statement closely and initial acknowledging your understanding
This company is committed to the principles of equal employment opportunity and is committed to make employment decisions based on merit. We are committed to complying with all Federal, State and local laws providing for equal employment opportunities, as well as all laws related to terms and conditions of employment. The Company desires to maintain a work environment that is free of sexual harassment and discrimination due to race, religion, color, national origin, [sexual orientation,] physical or mental disability, [marital status,] age or any other status protected by Federal, State or local laws. The Company will make reasonable efforts to accommodate those physical or mental limitations of an otherwise qualified employee unless undue hardship would result for the company. *
 
DISCRIMINATION AND SEXUAL HARASSMENT STATEMENT
Please read the statement closely and initial acknowledging your understanding
This Company will not tolerate any form of unlawful discrimination, including sexual harassment. Any employee who engages in unlawful discrimination or sexual harassment will be subject to appropriate discipline, up to and including termination. Prohibited sexual harassment is defined as follows: Unwelcome sexual advances, requests for sexual favors and other verbal or physical conduct of a sexual nature constitutes sexual harassment when (1) Submission to such conduct is made whether explicitly or implicitly a term or condition of an individual's employment; (2) Submission to or action of such conduct by an individual is used as the basis for employment decisions affecting such individuals; or (3) Such conduct has the purpose or effect of unreasonably interfering with an individual's work performance or creating an intimidating, hostile or offensive work environment. *
 
DISCLOSURE TO APPLICANTS CONCERNING DRUG/ALCOHOL TESTING
Please read the statement closely and initial acknowledging your understanding
If you are offered a position with the Company, you may be given a drug/alcohol test as a condition of employment. Your refusal to submit to a drug/alcohol test or your failure to pass such a test means you will not be employed by this company. Neither the collector of specimens nor the medical professional who reviews the test results will be a company employee. The test results will be kept confidential. The individual undergoing testing will not be directly observed while providing the specimen unless there are reasonable grounds to believe the individual may alter or substitute the specimen. Negative test results are required as a condition of employment. *
 
COMPLETE AND ACCURATE INFORMATION
Please read the statement closely and initial acknowledging your understanding
I hereby certify that I have not knowingly withheld any information that might adversely affect my chances for employment and that the answers given by me are true and correct to the best of my knowledge. I further certify that I have personally completed this application. I understand that any omission or misstatement of material fact on this application, or any other document used to secure employment, shall be grounds for rejection of this application or for immediate discharge if I am employed, regardless of the time elapsed before discovery. *
 
AT-WILL EMPLOYMENT
Please read the statement closely and initial acknowledging your understanding
I understand and agree that if I am employed, my employment will be "at-will" which means that either the Company or I may terminate the employment relationship at any time, with or without cause or notice. Likewise, the Company will respect my right to terminate my employment at any time, with or without notice and with or without cause. I further understand that any prior representation, whether expressed or implied is hereby superceded and that no promise or representation contrary to the foregoing is binding on the company unless it is made in writing and is signed by me and the company's designated representative. *
 
TESTING
Please read the statement closely and initial acknowledging your understanding
If offered a position with the Company, I hereby agree to any physical, psychological, skill, drug or medical test required by the Company as a legal condition of employment. *
 
WORK SCHEDULE
Please read the statement closely and initial acknowledging your understanding
I understand that work schedules are subject to change at any time and that overtime may be required. *
 
COMPANY OBLIGATION
Please read the statement closely and initial acknowledging your understanding
I understand and agree that the Company's acceptance of this job application does not mean that a position for which I am qualified is open (unless specifically posted) or that the company has agreed to hire me. I understand that the Company is under no obligation to hire me as the result of accepting this completed application. *
I HAVE READ AND UNDERSTAND THE ABOVE POLICY STATEMENTS AND AGREE TO BE BOUND BY THEM IF EMPLOYED BY THE COMPANY. *
  Initial and date
* indicates required fields

I hereby certify that I have a genuine interest in being hired and that all of the foregoing statements are true and correct. I agree to assume a continuing responsibility to disclose additional or new information, called for by this Employment Application, but known to me only after this Application was completed, and understand that my failure to make such a disclosure, and that falsification of any of the information given herein, on any employment form or in any interview, are grounds for immediate termination, regardless of when such failure or falsification may be discovered.

I also understand that my employment may be terminated at any time, with or without cause, without liability to me for salary, wages, or other benefits except as may have been earned up to date of the termination of services.
 



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