Employment Form Employment Application We would love to hear from you! Please fill out this form and we will get in touch with you shortly. * Please indicate that you've read the following before completing application... 1. There is no guarantee of a job offer or job interview by completing this application form. Your application will be considered with others who have submitted applications and decisions concerning interviews will be based on this comparison. 2. This application form must be filled out in its entirety in order for it to be considered for employment. 3. If the information provided on your application cannot be satisfactorily verified by employment reference checks, your application could be considered as incomplete. 4. Applications are filed according to job title. Be as specific as possible in stating the job applying for. "ANY POSITION" is not an acceptable response on this application form. 5. Due to the large number of applications we receive and the competitive nature of our employment process, specific reasons for employment decisions will not be released. 6. In completing this application form you will be subject to the following checks: Employment Reference Check Criminal Record Check Applicant DetailsName* First Last Today's Date* MM slash DD slash YYYY Any Previous Names Phone Number*Alternate Phone NumberEmail* Current Street Address* City* Zipcode* How did you hear about this position?* Are you 18 years of age or older?* Yes No Applicant NoteThis application form is intended for use in evaluating your qualifications for employment. This is not an employment contract. Please answer all appropriate questions completely and accurately. False or misleading statements during the interview and on this form are grounds for terminating the application process or, if discovered after employment, terminating employment. All qualified applicants will receive consideration without discrimination because of sex, marital status, race, age , creed, national origin or the presence of disabilities. A felony conviction will not necessarily bar an applicant from employment. Additional testing of job-related skills and for the presence of drugs in your body may be required prior to employment. After an offer of employment, and prior to reporting to work, you are required to submit to a medical review. Depending on company policy and the needs of the position, you will be required to complete a medical history form and may be required to be examined by a medical professional designated by the company. Job-Related SkillsFor which position are you applying?* Shift Preference* Full Time Part Time Temporary Shift Preference Continued*7am - 3pm3pm - 11pm11pm - 7amWeekendsHolidaysSpecial Skills AvailabilityValid Driver's License / State ID Number* Do you have your own transportation?* Yes No Have you been given a Job Description?* Yes No Are you able to perform the requirements of this job?* Yes No Please comment on your availability and desired time schedule:* SecurityHave you used any names other than given above? If so, please list in comments below.* Yes No Have you been convicted of, or served time for a felony in the past seven years? If so, please describe in the boxes below. (In accordance with company policy this information will be reviewed for job relatedness and time since last conviction.)* Yes No Incident City/State Charge Incident 2 City/State Charge Incident 3 City/State Charge Comments Previous Employers* I have read and understand the following: Please note: Your application will not be considered unless every question in this section is answered. Since we will make every effort to contact previous employers, the correct telephone numbers of past employers are official. Ask for a phone book or call information if you need. For employers outside the U.S., a correct fax number is mandatory. Most Recent EmployerAre you currently working for this employer?* Yes No If yes, may we contact?* Yes No Company Name* City* State* Phone* Fax Start of Employment* MM slash DD slash YYYY End of Employment* MM slash DD slash YYYY Job Title* Supervisor Name* Duties* Salary/Wage Reason for Leaving* Second Most Recent EmployerCompany Name City State Phone Fax Start of Employment MM slash DD slash YYYY End of Employment MM slash DD slash YYYY Job Title Supervisor Name Duties Salary/Wage Reason for Leaving Third Most Recent EmployerCompany Name City State Phone Fax Start of Employment MM slash DD slash YYYY End of Employment MM slash DD slash YYYY Job Title Supervisor Name Duties Salary/Wage Reason for Leaving ReferencesFirst ReferenceName* Address* Phone*Relationship/Years Known* Second ReferenceName* Address* Phone*Relationship/Years Known* EducationHighest Grade Completed*910111213141516Please enter the name that your school records are under. (For example, your maiden name if you went to school before you were married.)* High School(s) College(s) Other Certification and ReleaseI certify that I have read and understand the applicant note at the top of this form and the answers given by me to the foregoing questions and the statements made by me are complete and true to the best of my knowledge and belief. I understand that any false information, omissions or misrepresentations of facts called for in this application may result in rejection of my application or discharge at any time during my employment. I authorize the company and/or its agents, including consumer-reporting bureaus to verify any of this information. I authorize all former employers, persons, schools, companies and law enforcement authorities to release any information concerning my background and hereby release any said persons, schools, companies and law enforcement authorities from any liability for any damage whatsoever for issuing this information. I also understand that the use of illegal drugs is prohibited during employment. If company policy requires, I am willing to submit to drug testing to detect the use of illegal drugs prior to and during employment.* I certify that I have read and understand the applicant note at the top of this form and the answers given by me to the foregoing questions and the statements made by me are complete and true to the best of my knowledge and belief. I understand that any false information, omissions or misrepresentations of facts called for in this application may result in rejection of my application or discharge at any time during my employment. I authorize the company and/or its agents, including consumer-reporting bureaus to verify any of this information. I authorize all former employers, persons, schools, companies and law enforcement authorities to release any information concerning my background and hereby release any said persons, schools, companies and law enforcement authorities from any liability for any damage whatsoever for issuing this information. I also understand that the use of illegal drugs is prohibited during employment. If company policy requires, I am willing to submit to drug testing to detect the use of illegal drugs prior to and during employment.
