Employment Application

EMAIL ADDRESS: *

NAME (First, Middle, Last): *

CURRENT ADDRESS
(Please include Street, City, State and Zip Code): *

HOME PHONE: *

CELL PHONE:

FOR WHICH POSITION ARE YOU APPLYING?: *

PLEASE INDICATE THE SHIFTS YOU WOULD BE AVAILABLE TO WORK:

PART TIME: *

FULL TIME: *

SUNDAY – THURSDAY 3 PM – 10 PM: *

MONDAY – FRIDAY 7 AM – 3 PM: *

SLEEP NIGHTS – 10 PM – 7 AM: *

WEEKEND – EVERY OTHER FRIDAY 3 PM – SUNDAY 3 PM: *

OTHER:

ARE YOU OVER THE AGE OF 18?: *

WAGE DESIRED *

NUMBER OF HOURS PER WEEK DESIRED *

HAVE YOU EVER WORKED FOR US BEFORE? *

IF YES, WHEN?

HAVE YOU EVER BEEN A MEMBER OF THE ARMED FORCES? *

IF YES, WHAT BRANCH?

ARE YOU PRESENTLY A GUARDS OR RESERVE MEMBER? *

IF THE JOB REQUIRES, DO YOU HAVE THE APPROPRIATE VALID DRIVERS LICENSE? *

….STATE OF ISSUE *

HAVE YOU EVER HAD ANY MOVING VIOLATIONS? *

IF YES, PLEASE DESCRIBE

HAVE YOU USED ANY NAMES OTHER THAN GIVEN ABOVE? *

IF YES, PLEASE LIST

HAVE YOU EVER BEEN CONVICTED OF A CRIME IN THE PAST FIVE YEARS? *

IF YES, PLEASE DESCRIBE INCLUDING THE INCIDENT, CITY/STATE AND THE CHARGE.
(Conviction will not necessarily be a bar to employment in accordance with company policy and applicable state and federal laws. Factors such as age at time of the offense, remoteness of the offense, time since last conviction, nature of the job sought and rehabilitation effort will be reviewed)

MOST RECENT EMPLOYER INFORMATION

….COMPANY NAME *

….CITY *

….STATE *

….PHONE NUMBER *

….FAX NUMBER

….SUPERVISOR NAME *

….DUTIES

….SALARY EARNED *

….JOB TITLE *

DATES OF EMPLOYMENT *

….REASON FOR LEAVING *

ARE YOU CURRENTLY WORKING FOR THIS EMPLOYER? *

IF YES, MAY WE CONTACT?

SECOND MOST RECENT EMPLOYER *

….COMPANY NAME *

….CITY *

….STATE *

….PHONE NUMBER *

….FAX NUMBER

….SUPERVISOR NAME *

….DUTIES *

….SALARY EARNED *

….JOB TITLE *

DATES OF EMPLOYMENT *

….REASON FOR LEAVING *

ARE YOU CURRENTLY WORKING FOR THIS EMPLOYER? *

IF YES, MAY WE CONTACT? *

WORK REFERENCE…PLEASE INCLUDE NAME, ADDRESS, PHONE, RELATIONSHIP WITH AND NUMBER OF YEARS KNOWN. NO RELATIVES PLEASE. *

WHAT IS THE HIGHEST GRADE OF EDUCATION YOU COMPLETED? *

HIGH SCHOOL NAME, LOCATION AND SUBJECTS STUDIED *

….DID YOU GRADUATE? *

COLLEGE/VOCATIONAL SCHOOL NAME, LOCATION AND SUBJECTS STUDIED

….DID YOU GRADUATE? *

BY CHECKING THIS BOX I CERTIFY THAT ANSWERS GIVEN HEREIN ARE TRUE AND COMPLETE TO THE BEST OF MY KNOWLEDGE. PLEASE READ ALL INFORMATION ABOVE REGARDING THE RELEASE OF THIS INFORMATION. *
 I Agree

YOUR NAME AND TODAY’S DATE *