Instructions : It is the policy of the company to provide equal opportunity with regard to all terms and conditions of employment. The company complies with federal and state laws prohibiting discrimination on the basis of race, color, religion, creed, national origin, disability, veteran status, age, or any other protected characteristic.
Name:
E-mail:
Address:
City:
State:
Zip Code:
Phone:
Position applied for:
Shift preferred : 1
Expected pay:
Would you accept full-time work? Yes
Would you accept part-time work? Yes
On what date would you be available for work?
Have you ever been employed here before? Yes
If you are under 16 years old, can you provide a work permit if required? Yes
Are you able to perform the essential functions of the job for which you are applying(with or without reasonable accommodation)? This question is not designed to ellicit information about an applicant's disability. Please do not provide information about the existence of a disability, particular accommodation, or whether accommodation is necessary. These issues may be addressed at a later stage to the extent permitted by law. Yes
Explain any gaps in your employment, other than those due to personal injury,injury or disability:
Have you ever been fired or asked to resign from a job? Yes
Special training or skills: Languages, Machine operation, etc. that would be of benefit in the job for which you are applying:
Are you legally eligible for employment in the United States?
Yes
Employment Experience
1. Employer:
Address:
Phone:
Job Title:
Supervisor:
Dates Employed here: from (mm/yy)
Hourly rate/salary: starting
Work Performed:
Reason for Leaving:
2. Employer:
Address:
Phone:
Job Title:
Supervisor:
Dates Employed here: from (mm/yy)
Hourly rate/salary: starting
Work Performed:
Reason for Leaving:
3. Employer:
Address:
Phone:
Job Title:
Supervisor:
Dates Employed here: from (mm/yy)
Hourly rate/salary: starting
Work Performed:
Reason for Leaving:
Educational Background
Grammar School: Name of School:
Location:
Course of Study:
Did you graduate? Yes
Degree or Diploma:
Years completed:
High School: Name of School:
Location:
Course of Study:
Did you graduate? Yes
Degree or Diploma:
Years completed:
College: Name of School:
Location:
Course of Study:
Did you graduate? Yes
Degree or Diploma:
Years completed:
Graduate School: Name of School:
Location:
Course of Study:
Did you graduate? Yes
Degree or Diploma:
Years completed:
Vocational School: Name of School:
Location:
Course of Study:
Did you graduate? Yes
Degree or Diploma:
Years completed:
Continuing Education:
