Careers Interested in becoming part of the team? Follow the directions below. Application for Employment We are an equal opportunity employer and make employment decisions without regard to race, color, religion, sex, national origin, citizenship, age, disability or any other protected trait. No question on this application is used for the purpose of limiting or excluding any applicant from consideration for employment on any basis prohibited by local, state, or federal law. If you need an accommodation in completing this application, please notify a representative of the organization. Name * First Middle Last Address (Street, City, State, Zip Code): * Mailing Address (Street, City, State, Zip Code): Email Address * Phone No. * Are you legally eligible to work in the U.S,? * Yes No How were you referred to us? * During the past seven years, have you been convicted of, or have you pleaded guilty or no contest to, a felony offense? * Yes No If yes to the question above, please explain: Employment Desired Position Desired * Earliest Date You Can Start * Type of Employment Desired: (Choose one) * Full-time Part-time Temporary Do you have any objection to the following: Working Overtime * Yes No Working Evening Shifts: * Yes No Working Weekends * Yes No Employment History (Please provide all employment information for your past three employers.) Are you presently employed? * Yes No May we contact your current employer? Yes No Name of Current Employer Address of current Employer Position Held Rate of Pay Dates of Employment From To Immediate Supervisor Contact Number Reason for Leaving Eligible for Re-Hire Yes No Name of Employer Address of Employer Position Held Rate of Pay Dates of Employment From To Immediate Supervisor Contact Number Reason for Leaving Elegible to Re-Hire Yes No Name of Employer Address of Employer Position Held Rate of Pay Dates of Employment From To Immediate Supervisor Contact Number Reason for Leaving Eliguble to Re-Hire Yes No Educational History Name and Location of School Number of years Attended Degree or Years Completed Other Skills And Qualifications: References (Please list three references not related to you, whom you have known for at least one year.) Reference #1 Name * Address * Phone Number * Years Acquainted * Reference #2 Name * Address * Phone Number * Years Acquainted * Reference #3 Name * Address * Phone Number * Years Acquainted * Certification & Release I certify that I have fully and accurately answered all questions and have given all information requested in this application for employment. I hereby authorize the potential employer to contact, obtain, and verify the accuracy of information contained in this application from all previous employers, educational institutions, and references. I understand that all such information is subject to verification by the potential employer, and hereby give my consent to the potential employer to investigate my background and qualifications. I understand that any intentional misrepresentation or material omission made by me on this application or during the hiring process may disqualify me from further consideration for employment or, if discovered after I am hired, may be grounds for my immediate termination, without notice, whenever it may be discovered. I understand that this is a drug free workplace and consent to compliance with this policy as a condition of employment. I agree to undergo any type of drug and/or alcohol testing that the potential employer may require at any time. I also understand that, if I am hired, I will be required to provide satisfactory proof of identity and legal work authorization within three days of my hire. Failure to submit such proof within the required time shall result in immediate termination of employment. I understand that submission of this application does not necessarily mean that I will be hired. If I am hired, I acknowledge that there is no specified length of employment and that this application does not constitute an agreement or contract for employment. I understand that no company representative, other than its Owner, can enter into any employment contract with me and any such contract must be in writing and signed by both parties. Accordingly, either I or my employer can terminate the relationship at-will, with or without cause, at any time, so long as there is no violation of applicable federal or state law. I have read and fully understand the foregoing statements and I seek employment under the conditions set forth above. Signature of Applicant (Type Full name to Sign) * Date
