Employment Opportunities

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   2 3   Any
Expected pay:
Would you accept full-time work? Yes  No
Would you accept part-time work? Yes  No
On what date would you be available for work?
Have you ever been employed here before? Yes   No
Dates employed here:
If you are under 18 years old, can you provide a work permit if required? Yes   No
Are you able perform the essential functions of the job for wich 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   No
Need more information about the job's essential functions to respond :
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   No
If yes, please explain:
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? If yes, proof is required. Yes   No
Employment Experience
Please list your past employer(s) most recent first.
1. Employer:
Address:
Phone:
Job Title:
Supervisor:
Dates Employed here: from (mm/yy)   
to (mm/yy)
Hourly rate/salary: starting    final
Work Performed:
Reason for Leaving:


2. Employer:
Address:
Phone:
Job Title:
Supervisor:
Dates Employed here: from (mm/yy)   
to (mm/yy)
Hourly rate/salary: starting    final
Work Performed:
Reason for Leaving:


3. Employer:
Address:
Phone:
Job Title:
Supervisor:
Dates Employed here: from (mm/yy)   
to (mm/yy)
Hourly rate/salary: starting    final
Work Performed:
Reason for Leaving:

Educational Background
Grammar School: Name of School:
Location:
Course of Study:
Did you graduate? Yes    No
Degree or Diploma:
Years completed:


High School: Name of School:
Location:
Course of Study:
Did you graduate? Yes    No
Degree or Diploma:
Years completed:


College: Name of School:
Location:
Course of Study:
Did you graduate? Yes    No
Degree or Diploma:
Years completed:


Graduate School: Name of School:
Location:
Course of Study:
Did you graduate? Yes    No
Degree or Diploma:
Years completed:


Vocational School: Name of School:
Location:
Course of Study:
Did you graduate? Yes    No
Degree or Diploma:
Years completed:


Continuing Education:


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