Apply Now

Personal History

Last Name *

First Name *

Middle Initial

Street Address *

Apartment

City *

State *

ZIP Code *

Home Phone *

Cell Phone

Email Address *

How did you learn about this job opportunity? *

Have you ever worked for this Company before? *

Yes

Position applying for: *

Part Time

Full Time

Wages Expected ($) *

Job(s) applying for *

Are you on a lay-off and subject to recall? *

Yes

When would you be available to work? *

What hours/days are you able to work? *

Weekend work? *

Yes

Would you be available to work evenings? *

Yes

Are you available for overtime? *

Yes

Will you relocate if job requires it? *

Yes

Are you legally authorized to work in the U.S. without sponsorship? *

Yes

The Company will attempt to reasonably accommodate an applicant’s religious needs, as required by law.

Do you have reliable transportation? *

Yes

Do you have a valid Driver’s License? *

Yes

If you are under age 18, please provide date of birth

Can you provide work permit? *

Yes

In case of emergency, notify: *

Relationship *

Address *

Phone *

Have you ever been charged with, plead (no contest), been convicted of, or been fined in connection with any felony, misdemeanor, municipal ordinance violation, or any other type of offense (other than a parking ticket), regardless of the nature of the penalty or the fine for that offense? *

Yes

Skills and Qualifications

Please detail your skills and qualifications? *

Education

Highest grade completed (1-12) *

High School Diploma *

Yes

GED/HSED *

Yes

Technical School/College (years attended)

Major/Course of Study

Degree Received

Yes

Last School Attended *

Location *

Date(s) *

Additional education and/or vocational or technical information

Describe your computer skills and abilities *

Work History

Please provide full and accurate details regarding all full-time and part-time work history. Do not omit any employer. You must complete this section even if you provide a resume.

Number of Previous Employers

Employment or Personal References

List three (3) Employment or Personal References – DO NOT LIST RELATIVES

Name *

Address or Email *

Phone Number *

Company

Position

Name *

Address or Email *

Phone Number *

Company

Position

Name *

Address or Email *

Phone Number *

Company

Position

List any relatives currently employed at the Company

We comply with all prohibitions on marital status discrimination as required under applicable state law.

Number of Relatives Currently Employed at the Company

Military Services

If applicable. Our Company’s policy will comply with the Uniformed Services Employment and Reemployment Rights Act (USERRA).

Length of Service

Rank held in Service

Do you have any ongoing military obligations?

Present Status

None

Discharged

Retired

National Guard

Reserves

Indicate any special training or assignment that you want us to consider.

Resume/Cover Letter

If you have a resume or a cover letter, you may attach them here.

Certification

I certify that the information that I have provided to the Company as part of this application along with any resume or other material submitted by me for employment consideration is true, complete, and without omissions or misleading statements. I understand that my employment may be terminated because of false, misleading, or omitted information, regardless of the time that may have elapsed between furnishing the information and the discovery by the Company.

I authorize the Company to inquire into my education, professional and past employment history with references as needed to determine my qualifications and suitability for employment. I hereby give my consent to any former employer or educational institution to provide academic or employment related information about me to the Company. This includes any pertinent information they may have, personal or otherwise, and I release all parties from all liability for any damage that may result from furnishing this information.

I understand that I may be required to pass a pre-employment drug test and that my Social Security number must be validated. I further acknowledge that certain positions with the Company may also require a confirmation that I am licensed to drive a motor vehicle, and that my credit, civil and criminal records may be checked including a verification of my address. I consent freely and voluntarily to participate in the required drug test and background checks, and consent to the release of the results to the Company. I hereby release and hold harmless the Company from any liability whatsoever arising from the drug test and/or background checks and decisions concerning employment based upon the results of these tests and checks.

I understand that nothing in this employment application, the granting of an interview, or possible subsequent employment offer is intended to create an employment contract between the Company and myself. If hired, I will be an “Employee at Will” which means the Company may release me at any time for any reason with or without cause, and I am likewise free to leave at any time for any reason. I understand that no representative of the Company other than the President or Chief Executive Officer has any authority to enter into any agreement for employment that contradicts or modifies the foregoing in any manner, and any such agreement must be in writing and signed by the President or Chief Executive Officer.

If hired, I agree to conform to rules, regulations, and policies that the Company may periodically issue, withdraw, or modify. If hired, I understand that I will be required to keep my hair color within the range of “natural” colors (no blue, green, or other non-natural hair colors are allowed) and that facial piercings are not appropriate. I also understand that in order to comply with Company policy any visible tattoos may need to be covered appropriately during the workday, if hired. I agree to follow the Company grooming guidelines and to be dressed appropriately per the standards of the Company at all times in the workplace, if I am hired.

A photocopy, digital, and/or electronic copy of this signed authorization is as effective and binding as the original.

Signed (First, M.I., Last) *

Date *