EMPLOYMENT APPLICATIONEmployment FormStep 1 of 333%It is our policy to comply with all applicable state and federal laws prohibiting discrimination in employment based on race, age, color, sex, religion, national origin, disability or other protected classifications.Please carefully read and answer all questions. You will not be considered for employment if you fail to completely answer all the questions on this application. You may attach a resume, but all questions MUST be answered.Position Applying ForPERSONAL DATAName(Required) First Last Suffix Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Home Telephone NumberCellular Telephone NumberBusiness PhoneDate you can start workDesired SalaryDo you have a HIgh School Diploma or GED? Yes NoPOSITION INFORMATIONCheck all that you are willing to work.Hours Full Time Part TimeShifts Days Evenings WeekendsAre you authorized to work in the U.S. on an unrestricted basis? Yes NoHave you ever been convicted of a felony? Yes NoIf yes, please explain:SPECIAL SKILLSPlease list any special skills you have for the job you are applying for.REFERENCESReference #1 - NameAddress Street Address Address Line 2 City State / Province / Region ZIP / Postal Code PhoneRelationshipReference #2 - NameAddress Street Address Address Line 2 City State / Province / Region ZIP / Postal Code PhoneRelationshipI certify that the facts set forth in this Application for Employment are true and complete to the best of my knowledge. I understand that if I am employed, false statements, omissions or misrepresentations may result in my dismissal. I authorize the Employer to make an investigation of any of the facts set forth in this application and release the Employer from any liability. The employer may contact any listed references on this application.I acknowledge and understand that the company is an “at will” employer. Therefore, any employee (regular, temporary, or other type of category employee) may resign at any time, just as the employer may terminate the employment relationship with any employee at any time, with or without cause, with or without notice to the other partySignatureDate MM slash DD slash YYYY CAPTCHAΔ
