Hourly Employment Application

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Each question should be fully and accurately answered. No action can be taken on this application until all questions have been answered. All information given will be available only to persons who have a “need to know” or as required by law. This company will make reasonable accommodation in the application process, if needed. Qualified applicants for salary positions must submit to and successfully pass a criminal background check and drug screen. A conviction on the criminal background check will not necessarily disqualify an applicant, and applicants will have the opportunity to disclose and discuss any convictions during the selection process.

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Managing Location*

Personal Information

Name*

Email*

Phone*

Are you legally eligible for employment in the U.S.?*

Yes

All new hires will be required to provide proof of eligibility to work in the U.S.

Are you over 18 years of age?*

Yes

Address*

Street Address Address Line 2 City State ZIP Code

List any friends or relatives working for us

Full Name

Phone Number

Relationship

Referred by

Full Name

Phone Number

Relationship

Employment Desired

Position*

Date you can Start*

Salary Desired

Which type of Employment are you seeking:*

Full-time

Part-time

Temporary / Variable

Are You Currently Employed?*

Yes

Ever applied/worked for this company before?*

Yes

How did you hear about this opportunity?*

Employee information making recommendation?

Full Name

Phone Number

Relationship

Education History

High School

Name & Location of School

Years Attended

Graduate (Y/N)

Area of Study

College

Name & Location of School

Years Attended

Graduate (Y/N)

Area of Study

Other job-related education

Name & Location of School

Years Attended

Graduate (Y/N)

Area of Study

List skills relevant to the position applied for:

For Driving Job Only:

Do you have a valid driver’s license?*

Yes

State Issued

License Number

If you are an experienced operator of any business/plant machines or equipment, please list:

For Office/Administrative positions only:

Typing WPM

10-Key*

Yes

Computer Proficiency:

Microsoft Word

Microsoft Excel

Other Computer Proficiencies:

Indicate languages you speak, read, and/or write: (reply optional)

Language

Speak

Read

Write

Record of Employement

Current/Most Recent Employer

Name of Employer

Employer Address

Employer Telephone

Type of Business

Date Started

Dates Ended

Reason for Leaving

Supervisor’s Name and Title

List the jobs you held, duties performed, skills used or learned, advancements or promotions.

Next Previous Employer

Name of Employer

Employer Address

Employer Telephone

Type of Business

Date Started

Dates Ended

Reason for Leaving

Supervisor’s Name and Title

List the jobs you held, duties performed, skills used or learned, advancements or promotions.

Next Previous Employer

Name of Employer

Employer Address

Employer Telephone

Type of Business

Date Started

Dates Ended

Reason for Leaving

Supervisor’s Name and Title

List the jobs you held, duties performed, skills used or learned, advancements or promotions.

Next Previous Employer

Name of Employer

Employer Address

Employer Telephone

Type of Business

Date Started

Dates Ended

Reason for Leaving

Supervisor’s Name and Title

List the jobs you held, duties performed, skills used or learned, advancements or promotions.

References

(Give below the names of three (3) professional references, who you have known for at least one year.)

Reference Information

(Give below the names of three (3) professional references, who you have known for at least one year.)

Name

Address

Phone

Business

Years Known

Authorization

This Employment Application is used to notify me that the nature and scope of an investigation, if one is conducted, could include such general identification information as residence verification, and, as applicable, information concerning my employment, education, general reputation, character, personal characteristics, and habits, and that such information may be developed through personal interviews with third parties such as family members, neighbors, friends, associates, former employers, educational institutions, custodians of official records or other sources. Only job-related information developed from such a report will be considered in evaluating my employment application or continued employment. I hereby authorize these persons, companies, organizations or corporations to answer all questions or release any information regarding the items listed in this paragraph. I hereby release them from any liability and hold them harmless from any claim for releasing any truthful information within their knowledge and/or records.

I authorize the Company to release to any person, firm, entity or organization with which I may seek employment in the future, any truthful information concerning my work experience with the Company. I hereby release and hold the Company harmless from any claim for releasing any truthful information within its knowledge and/or records.

I understand that any job offer that may be extended to me will be contingent upon the successful completion of a drug test.

I certify that the answers given by me to the foregoing questions and during any interviews are true and correct without consequential omissions, and understand that, if employed, omissions and/or false statements on this application or during any interviews may result in dismissal. I have had an opportunity to have my questions about this statement's content and intent answered and understand its terms.

Signature of Applicant*

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Hourly Employment Application

Personal Information

Employment Desired

Education History

Record of Employement

References

Authorization

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