APPLICATION FOR EMPLOYMENT

We consider applicants for all positions without regard to race, color, religion, creed, gender, national origin, age, disability, marital or veteran status, sexual orientation, or any other legally protected status

Date of Application:

Position Applied For::

How Did You Learn About Us?:

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Last Name: First Name: Middle Name: Address Number Street City State Zip Code: Telephone Number(s): Social Security #: -- If you are under 18 years of age, can you providerequired proof of your eligibility to work?: Yes No Have you everfiled an application with us before?: Yes No If yes give date: Are you currently employed?: Yes No Are you prevented from lawfully becoming employed in this country because of Visa or Immigration Status? (Proof of citizenship or immigration status will be required upon employment): Yes No On what date would you be available for work?: Are you available to work: Full Time Part Time Shift Work Temporary Are you currently on "lay-off" status and subject to recall?: Yes No Can you travel if a job requires it?: Yes No Have you been convicted of a felony within the last 7 years? {Conviction will not necessarily disqualify an applicant from employment): Yes No If yes, please explain:  Education: Name and Address of School: High School Name: Course of study:  Years Completed: Diploma Degree: -------------------------------------------------------------------- College Name: Course of Study: Years Completed: Diploma Degree: ----------------------------------------------------------------- Other Schooling (Specify): Describe any job-related training received in the United States Military: EMPLOYMENT EXPERIENCE Start with your present job. Include any job-related military service assignments and volunteer activities. You may exclude organizations which indicate race, color, religion, gender, national origin, disabilities or other protected status. Employer1: Address: Telephone Number(s): Dates Employed From - To: Job Title: Work Performed: Supervisor: Hourly Rate/Salary Starting & Final: Resaon For Leaving: Personal References 1. Name: Phone: Address: 2. Name: Phone: Address: 3. Name: Phone: Address: APPLICANT'S STATEMENT I certify that answers given herein are true and complete to the best of my knowledge. I authorize investigation of all statements contained in this application for employement as may be necessary in ariving at an employement decision. This application shall be considered for a period of time not to exceed 45 days. Any applicant wishing to be considered for employment beyond this time period should inquire as to whether or not applications are being accepted at that time. I hereby understand and acknowledge that, unless otherwise defined by applicable law, any employment relationship with this organization is of an "at will" nature, which means that the Employee may resign at any time and the Employer may discharge Employee at any with or without cause. It is further understood that this "at will" employment relationship may not be changed by any written document or by conduct unless such change is specifically acknowledged in writing by an authorized executive of this organization. In the event of employment, I understand that false or misleading information given in my application, or interview(s) may result in discharge. I understand, also, that I am required to abide by all rules and regulations of the employer. Click here if you agree Date