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Conditions of employment are stated at the end of this form. Please read carefully before you sign this application (Application must be completed in full.)
Position Applied For
Desired Salary
Date of Application
Date Available
Full Name
Alias Name
Address
How long have you resided at your current address
Previous Address
How long did you reside there
Home Phone Number
Cell Phone Number
Email
SCHEDULE
Please keep in mind that schedules and shift may vary depending on season and position. Additionally, the hours may vary from week to week, depending on the company needs. Please list only the times/days your are available to work below.
SPECIFY HOURS AVAILABLE DAILY
SUNMON TUESWEDTHURFRISAT
AM
PM
Are you less than 18 years of age? (If yes, you will need to present a work permit.)
- Yes No
Do you have reliable means of transportation?
- Yes No
Do you have a valid driver's license?
- Yes No
Do you have a valid driver's license?
- Yes No
Have you ever been discharged from any employment or asked to resign?
- Yes No
If yes, please explain
Do you have any family members and/or friends at this company?
- Yes No
If yes, please explain
Were you referred to this position by anyone?
- Yes No
If yes, please explain
Have you ever been convicted of a criminal offense, felony or serious misdemeaNor in the last 7 years?
- Yes No
If yes, list nature of crimes, when and where convicted and disposition of the case
Are you able to perform the essential functions of the job that you are applying for?
- Yes No
List any reasonable accommodations needed
Are you able to work overtime?
- Yes No
Have you worked at this company before?
- Yes No
If yes, provide job title, location and dates of employment
EDUCATION & SKILLS
Name of School
City & State
Grade or Degree Completed
- Did you Graduate? Yes No
Name of School
City & State
Grade or Degree Completed
- Did you Graduate? Yes No
Do you have any special licenses, certificates or special training?
- Yes No
If so, please list
Are you trained to drive a forklift?
- Yes No
If so, indicate the type of fork lift you've driven
Do you have any special skills Not listed that are relevant to this position?
- Yes No
If so, please list
Are you proficient with Microsoft Word and Excel?
- Yes No
Are you computer literate?
- Yes No
If so, please list software kNowledge
EMPLOYMENT HISTORY
Begin with your most recent employment [1] and continue with 7 years of past employment
1. Employer
from to
Job Title
Name of Company
Describe Your Duties
Address
Starting Salary: $ Ending Salary: $
Telephone
Name & Title of Immediate Supervisor
Reason for Leaving
- May We Contact Your Employer? Yes No
2. Employer
from to
Job Title
Name of Company
Describe Your Duties
Address
Starting Salary: $ Ending Salary: $
Telephone
Name & Title of Immediate Supervisor
Reason for Leaving
- May We Contact Your Employer? Yes No
3. Employer
from to
Job Title
Name of Company
Describe Your Duties
Address
Starting Salary: $ Ending Salary: $
Telephone
Name & Title of Immediate Supervisor
Reason for Leaving
- May We Contact Your Employer? Yes No
4. Employer
from to
Job Title
Name of Company
Describe Your Duties
Address
Starting Salary: $ Ending Salary: $
Telephone
Name & Title of Immediate Supervisor
Reason for Leaving
- May We Contact Your Employer? Yes No
REFERENCES
Give below four (4) business references, which you have kNown for at least one (1) year
Name Business Name Phone Number/Email Years Aquainted
I certify that all answers given by me are true, accurate and complete, I understand that the falsification, misrepresentation or omission of fact on this application (or any other accompanying or required documents) will be cause for denial of employment or immediate termination of employment, regardless of when or how discovered. I further certify that I, the undersigned applicant, have personally completed this application.
It is the policy of the company to afford equal opportunity to all employees and applicants for employment without regard to age, race, religion, color, sex, gender bias, national origin, marital status, expunged juvenile records, or pregnancy, and any and other characteristic protected by Federal, State or Local law.
I authorize the investigation of all statements and information contained in this application. I authorize the references I have listed to disclose to the company any and all letters, reports and other information related to my work records, without giving me prior Notice of such disclosure. In addition, I hereby release the company, my former employers and all other persons, corporations, partnerships and associations from any and all claims, demands or liabilities arising out of or in any way related to such investigation or disclosure. California Only: Applicants may omit any convictions for the possession of Marijuana that are more than two (2) years old, and any information or referral to, and participation in, pretrial or post trial diversion program.
I understand that Nothing contained in the application, or conveyed during any interview which maybe granted or during my employment, if hired, is intended to create an employment contract between me and the company. In addition, I understand and agree that if I am employed, my employment is at will, for No definite or determinable period and may be terminated at any time, with or without prior Notice,at the option of either myself or the company, and that No promises or representations contrary to the foregoing are binding on the company unless made in writing and signed by me and the company's designated representative.
I ackNowledge that I have read and understand the above statements and hereby grant permission to confirm the information supplied on this application by me.

SCHEDULE

EDUCATION & SKILLS

EMPLOYMENT HISTORY

REFERENCES

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