Application for Employment

Instructions: It is the policy of the company to provide equal opportunity with regard to all terms and conditions of employment. The company complies with federal and state laws prohibiting discrimination on the basis of race, color, religion, sex, national origin, disability, veteran status, age, or any other protected characteristic.

 

 
 
 
 
 
Shift Preferred :                  
 
 
Would you accept full-time work?      
Would you accept part-time work?      
 
Have you ever been employed here?      
 
If you are under 18 years old, can you provide a work permit if required?
     
 
Are you eligible for employment in the United States? (If yes, proof is required if hired.)      
 
Are you able to perform the essential functions of the job for which you are applying (with or without reasonable accommodation)? This question is not designed to elicit information about an applicant's disability. Please do not provide information about the existence of a disability, particular accommodation, or whether accommodation is necessary. These issues may be addressed at a later stage to the extent permitted by law.
           
 
Explain any gaps in your employment, other than those due to personal illness, injury or disability.
 
Have you ever been fired or asked to resign from a job?      
 

Special Training or Skills

 
Languages, machine operation, etc., that would be of benefit in the job for which you are applying.
 

Employment Experience

 
Dates Employed
Hourly Rate/Salary
Work Performed:
Reason for Leaving:
Do you want us to contact employer?
 
Dates Employed
Hourly Rate/Salary
Work Performed:
Reason for Leaving:
Do you want us to contact employer?
 
Dates Employed
Hourly Rate/Salary
Work Performed:
Reason for Leaving:
Do you want us to contact employer?
 
Dates Employed
Hourly Rate/Salary
Work Performed:
Reason for Leaving:
Do you want us to contact employer?
 

Educational Background

 
     
 
     
 
     
 
     
 
Continuing Education

I certify that all the information submitted by me on this application is true and complete, and I understand that if any false or misleading information, omissions or misrepresentations are discovered, my application may be rejected, and if I am employed, my employment may be terminated at any time.

If hired, I agree to conform to the company's rules and regulations, and I understand that these rules and/or the employee handbook do not form a contract of employment either expressed or implied, and I agree that my employment and compensation can be terminated, with or without cause and with or without notice, at any time, at either my or the company's option.I also understand and agree that the terms and conditions of my employment may be changed, with or without cause and with or without notice, at any time by the company. I understand that no company representative, other than its president, and then only when in writing and signed by the president, has any authority to enter into any agreement for employment for any specific period of time, or to make any agreement contrary to the forgoing.

I expressly authorize, without reservation, the employer, its representatives, employees or agents to contact and obtain information from all references (personal and professional), employers, public agencies, licensing authorities and educational institutions and to otherwise verify the accuracy of all information provided by me in this application, resumé or job interview. I hereby waive any and all rights and claims I may have regarding the employer, its agents, employees or representatives, for seeking, gathering and using truthful and non-defamatory information, in a lawful manner, in the employment process and all other persons, corporations or organizations for furnishing such information about me.

I understand that this application remains current for only 30 days. At the conclusion of that time, if I have not heard from the employer and still wish to be considered for employment, it will be necessary for me to reapply and fill out a new application.