Step 1 of 4 25% APPLICATION FOR EMPLOYMENTAll portions of this application pertaining to you must be completed. We appreciate the time you will spend in completing this application. It is the policy and practice of this Company to provide all qualified employees and applicants for employment with equal opportunities without regard to age, race, religion, color, sex, pregnancy, ancestry, national origin, disability or any status or condition protected by applicable law. We provide, upon request, reasonable accommodations to assist applicants with disabilities in applying for employment.Name(Required) First Middle Last Phone(Required)Alternate PhoneSocial Security No.(Required) Address(Required) Street Address City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Are you legally entitled to work in the United States?(Required) Yes No Have you ever applied for a job with this company?(Required) Yes No If yes, where and when? The position you are applying for is:(Required) Hourly Wage Expected:(Required)Type of employment:(Required) Full Time Part Time Temporary Will you accept part-time employment? Yes No Please specify the days and hours you are available to work:(Required) If your application is considered favorable, on what date can you start to work?(Required) MM slash DD slash YYYY Is your current age 16 years or older?(Required) Yes No Is your current age 18 years or older?(Required) Yes No Can you work shifts?(Required) Yes No What shifts can you work? First (Early Mornings) Second (Afternoon-Evenings) Third (Nights) Can you work overtime?(Required) Yes No List any special skills or abilities related to the job applied for.(Required) Describe your greatest accomplishment from any previous position that you have held.(Required) Highest grade completed(Required) 1 2 3 4 5 6 7 8 9 10 11 12 GED College 1 year College 2 year College 3 year College 4 year High School Name(Required) High School Address(Required) No. of years attended(Required) Degree/Major(Required) College Name College Address No. of years attended Degree/Major Graduate School Name Graduate School Address No. of years attended Degree/Major Other School Name Other School Address No. of years attended Degree/Major Dates From:(Required) MM slash DD slash YYYY Dates to:(Required) MM slash DD slash YYYY Name and Address of Employer(Required) Supervisor's Name(Required) Supervisor's Phone Number(Required)May we contact them?(Required) Yes No Describe the type of work you did(Required) Starting Salary(Required)Ending Salary(Required)Exact reason for leaving(Required) Dates From:(Required) MM slash DD slash YYYY Dates to:(Required) MM slash DD slash YYYY Name and Address of Employer(Required) Supervisor's Name(Required) Supervisor's Phone Number(Required)May we contact them?(Required) Yes No Describe the type of work you did(Required) Starting Salary(Required)Ending Salary(Required)Exact reason for leaving(Required) Dates From:(Required) MM slash DD slash YYYY Dates to:(Required) MM slash DD slash YYYY Name and Address of Employer(Required) Supervisor's Name(Required) Supervisor's Phone Number(Required)May we contact them?(Required) Yes No Describe the type of work you did(Required) Starting Salary(Required)Ending Salary(Required)Exact reason for leaving(Required) Name and Occupation(Required) Address(Required) Street Address Phone(Required)Name and Occupation(Required) Address(Required) Street Address Phone(Required)Name and Occupation(Required) Address(Required) Street Address Phone(Required)Have you served in the U.S. Armed Forces?(Required) Yes No Branch of Service Total months of active duty Rank of Induction Highest Rank attained Specialized military experience Have you ever been convicted of a felony or misdemeanor other that a minor traffic offense which has not been pardoned or expunged from your record?(Required) Yes No If yes, list date, city, charge and disposition: This application will become inactive after 60 days. If you wish to be considered for employment after that time, you must complete a new application for employment. All applications will, however, be retained in our files for a period of twelve months. This company does not discriminate against qualified applicants or employees on the basis of race, creed, national origin, sex, ancestry, pregnancy, color, age or other status or condition protected by applicable law. However, we insist that all of our employees can perform the essential functions of their employment and have the character, integrity, and general reputation of honest of a person we would be willing to have to represent our company in its dealings with our clients, affiliates, suppliers, and/or other employees. Accordingly, we insist on complete honesty. ANY LATER DISCOVERY THAT AN APPLICANT WAS NOT HONEST IN COMPLETING THIS APPLICATION WILL BE GROUNDS FOR DISCHARGE. AFFIDAVIT: I authorize or instruct this company to make whatever inquiries it deems necessary (of any former employer, personal reference, or school official named in this application or referred by a person named in this application) in order to verify any information in my application and/or determine my qualifications and abilities and I agree to release and hold harmless those entities from any and all liability arising from the release of such information. I understand that such inquiries may include information as to my character, general reputation or personal characteristics. Statements I made on the application are true and complete. I understand that if, in the judgement of the Company I have made any false statements, omissions, concealments, any misrepresentations or I have failed to answer any questions fully and accurately, or results of such investigation are not satisfactory, any offer made by the Company may be withdrawn or my employment with the Company be terminated immediately, without any obligation to me other than for payment at the rate agreed upon for services rendered after I have been employed. I agree to conform to the rules and regulation of the Company, and understand that if I am hired, my employment and compensation can be terminated, with or without cause and with or without notice, at any time, at the option of either the Company or myself. I further understand that no personal recruiter or interviewer or other representative of the Company has any authority to enter into any agreement for employment for any specified period of time unless such an agreement is in writing and signed by the Company’s designated representative. Authorization Signature of Applicant:(Required) Date(Required) MM slash DD slash YYYY CAPTCHA
