Application for Employment

Pre-Employment Questionnaire - Equal Opportunity Employer

*Position Applied For: *Are you available for work? Full Time / Part Time
*Please Indicate: First Shift / Second Shift / Third Shift
   Days Available: Mon / Tues / Wed / Thurs / Fri / Sat / Sun

*Name: First Name: Middle Name Last Name *Address: City: State: Zip Code: *Cell Phone: - - *Home Phone: - - *Can you text? : Yes No
*E-Mail Address:

*Are You At Least 18 Years of Age? : Yes No
*Have You Ever Filed An Application With Us Before? : Yes No
*Have You Ever Been Employed By Us Before? : Yes No *Are You Prevented From Lawfully Becoming Employed In This Country Because of Visa or Immigration Status? :

   (Proof of citizenship or immigration status will be required upon employment)
   Yes    No *Have You Ever Been Convicted Of A Crime? :

   (A Certified BCI will be required prior to employment)
   Yes    No *Date You Are Available For Work: ______/______/________ *Do You Have Your Own Vehicle Available For Work? :

    (Vehicle registration required)
   Yes    No

Education: (High School Education or GED Required) *Highest Grade of School Completed:

   Do or Did You Attend Trade School Or College:    Yes    No    If So, Where:    Describe Any Specialized Training, Apprenticeship, Skills:

   

Employment Experience:

Employer:	Dates Employed	Work Performed
Address:	From: To:
Telephone: - -
Reason For Leaving:	Hourly Rate / Salary
Job Title:	Start: Final:
Employer:	Dates Employed	Work Performed
Address:	From: To:
Telephone: - -
Reason For Leaving:	Hourly Rate / Salary
Job Title:	Start: Final:
Employer:	Dates Employed	Work Performed
Address:	From: To:
Telephone: - -
Reason For Leaving:	Hourly Rate / Salary
Job Title:	Start: Final:

Character References: (References may be contacted during application screening processes)

Name:	Phone:	Relationship:
Name:	Phone:	Relationship:
Name:	Phone:	Relationship:

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No Question on this application is intended to secure information to be used for discrimination. I voluntarily give this institution the right to make a thorough investigation of my past employment and activities, agree to cooperate in such investigation and release from all liability or responsibility all persons, companies or corporations supplying such information. I understand that my employment is at will and that either party is free to terminate the employment relationship at any time without cause. I also understand that my employment may be terminated for any MISSTATEMENT or omission of fact appearing on this application. By selecting the "Submit Application" button, you are signing this employment application electronically. You agree your electronic signature is the legal equivalent of your manual signature on this employment application.


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