EMPLOYMENT APPLICATION

Applicant Contact Information

First Name*

Last Name*

Middle Initial

Address Line 1*

Address Line 2

City*

State*

Zip Code*

Phone Number*

Email*

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Position & Availability Information

Position Desired*

Salary Desired*

Date Available to Begin Work*

Are you at least 18 years of age??*

Are you at least 21 years of age?*

Are you legally eligible to work in the United States?*

PLEASE FILL IN YOUR AVAILABILITY

A Sunday	B Monday	C Tuesday	D Wednesday	E Thursday	F Friday	G Saturday

Education Information

A High School Name	B Address	C Number of Years	D Graduate?	E Degree/Certification

Did You Attend College?*

A College Name	B Address	C Number of Years	D Graduate?	E Degree/Certification

Did You Attend Trade School?*

A Trade School Name	B Address	C Number of Years	D Graduate?	E Degree/Certification

Any Additional Education Information?*

A Name	B Address	C Number of Years	D Graduate?	E Degree/Certification

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Reference Information

Reference 1

Name*

Street Address*

City*

State*

Zip Code*

Phone Number*

Reference 2

Name*

Street Address*

City*

State*

Zip Code*

Phone Number*

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Reference 3

Name*

Street Address*

City*

State*

Zip Code*

Phone Number*

Employment History

Employment History 1

Employer*

Supervisor*

Street Address*

City*

State*

Zip Code*

Phone Number*

Employment Dates*

Position*

Salary*

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Duties*

Reason for Leaving*

Do you have additional Employment History to add?*

Employment History 2

Employer*

Supervisor*

Street Address*

City*

State*

Zip Code*

Phone Number*

Employment Dates*

Position*

Salary*

Duties*

Reason for Leaving*

Do you have additional Employment history to add?*

Employment History 3

Employer*

Supervisor*

Address Line 1*

City*

State*

Zip Code*

Phone Number*

Employment Dates*

Position*

Salary*

Duties*

Reason for Leaving*

Do you have additional Employment History to add?*

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Employment History 4

Employer*

Supervisor*

Street Address*

City*

State*

Zip Code*

Phone Number*

Employment Dates*

Position*

Salary*

Duties*

Reason for Leaving*

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Other Information

How did you hear about us*

Referring Employee Name*

Describe how you heard about us*

Have you ever been convicted of a misdemeanor involving violent conduct, theft, or fraud or a felony? Have you ever received adjudication for a misdemeanor involving violent conduct, theft, or fraud or a felony? If yes to either, please describe and provide dates. (Answering yes will not necessarily disqualify you for employment, but failure to disclose it will.)*

Description of conviction or adjudication*

Date of conviction or adjudication*

Have you worked for us before or filed an application with us before?*

When*

Principal Information

Do you enjoy learning new things? What was the last new thing you learned?*

When you hear the word "excellence," what do you think of?*

Do you like to mark things off a list as you complete them? Or you prefer to keep things in your head?*

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Do you prefer to solve problems ahead of time, or fix them after they happen?*

Do you prefer working alone or on a team?*

Do you think consistency is important?*

I understand that false, misleading, incomplete, or omitted information on this application or exhibits or resumes may result in rejection of my application, or termination if hired, regardless of the date of discovery. I understand that this application is not an offer of employment or an employment contract with the company.

TERMS OF ACCEPTANCE AND SIGNATURE

I, the Applicant, for this acknowledgement, warrant the truthfulness of the information provided in this agreement.

Electronic Signature*

I understand that checking this box constitutes a legal signature confirming that I acknowledge and agree to the above Terms of Acceptance