Temporary work – such as summer or holiday work? YesNo
Regular part-time work? YesNo
Regular full-time work? YesNo
Can you work on the weekends? YesNo
Can you work evenings? YesNo
Are you available to work overtime? YesNo
Desired Salary/week: $
Have you ever applied to / worked for Company before? YesNo
Do you have any friends, relatives, or acquaintances working for Company? YesNo
If hired, would you have transportation to/from work? YesNo
Are you over the age of 18? (If under 18, hire is subject to verification of minimum legal age.) YesNo
If hired, would you be able to present evidence of your U.S. citizenship or proof of your legal right to work in the United States? YesNo
If hired, are you willing to submit to and pass a controlled substance test? YesNo
Are you able to perform the essential functions of the job for which you are applying, either with / without reasonable accommodation? YesNo
If no, describe the functions that cannot be performed
Note: Company complies with the ADA and consider reasonable accommodation measures that may be necessary for eligible applicants/employees to perform essential functions. It is possible that a hire may be tested on skill/agility and may be subject to a medical examination conducted by a medical professional.
Have you ever been convicted of a criminal offense (felony or misdemeanor)? YesNo
If yes, please describe the crime - state nature of the crime(s), when and where convicted and-disposition-of-the-case
Note: No applicant will be denied employment solely on the grounds of conviction of a criminal offense. The date of the offense, the nature of the offense, including any significant details that affect the description of the event, and the surrounding circumstances and the relevance of the offense to the position(s) applied for may, however, be considered.
Did you graduate? YesNo
Do you speak, write or understand any foreign languages? YesNo
If yes, describe which languages(s) and how fluent of a speaker you consider yourself to be:
Do you have any other experience, training, qualifications, or skills which you feel should be brought to our attention, in the case that they make you especially suited for working with us? YesNo
If yes, please explain:
Are you currently employed? YesNo
If you are currently employed, may we contact your current employer? YesNo
Below, please describe past and present employment positions, dating back five years, starting with the most recent one. Please account for all periods of unemployment. Even if you have attached a resume, this section must be completed.
May we contact this employer for references? YesNo
List three references who have knowledge of your work performance within the last four years. Please include professional references only.
I certify that I have not purposely withheld any information that might adversely affect my chances for hiring. I attest to the fact that the answers given by me are true & correct to the best of my knowledge and ability. I understand that any omission (including any misstatement) of material fact on this application or on any document used to secure can be grounds for rejection of application or, if I am employed by this company, terms for my immediate expulsion from the company. I understand that if I am employed, my employment is not definite and can be terminated at any time either with or without prior notice, and by either me or the company. I permit the company to examine my references, record of employment, education record, and any other information I have provided. I authorize the references I have listed to disclose any information related to my work record and my professional experiences with them, without giving me prior notice of such disclosure. In addition, I release the company, my former employers & all other persons, corporations, partnerships & associations from any & all claims, demands or liabilities arising out of or in any way related to such examination or revelation.
I accept the terms above.