We are an equal opportunity employer and do not unlawfully discriminate in employment. No question on this application is used for the purpose of limiting or excluding any applicant from consideration for employment on a basis prohibited by local, state, or federal law. Equal access to employment, services, and programs is available to all persons. Those applicants requiring reasonable accommodation to the application and/or interview process should notify a representative of the organization.

Are you seeking:     full time    part time    temporary

What hours and shift(s) would you prefer to work?

Are you able to meet the attendance requirements?     Yes    No  

Do you have any objection to working overtime if necessary?     Yes    No  

Can you travel if required by this position?     Yes    No  

Have you ever been previously employed by our organization?     Yes    No  

Can you submit proof of legal employment authorization and identity?     Yes    No  

If you are under 18, can you furnish a work permit if it is required?     Yes    No  

Have you been convicted of a crime (misdemeanor or felony) in the last 7 yrs?     Yes    No  

If yes, please explain (a conviction will not automatically bar employment)

Drivers license number (if driving is an essential job duty)

How were you referred to us?

Employment History
Please provide all employment information for your past four employers starting with the most recent.

 

 

 

Other Skills and Qualifications
Summarize any job-related training, skills, licenses, certificates, and/or other qualifications:

Educational History
List school name and location, years completed, course of study, and any degrees earned:

Emergency Contact(s)

References
List 3 references. Please include name, telephone number, and years known (do not include relatives or former/current employers):

I UNDERSTAND THAT ANY MISREPRESENTATION OR MATERIAL OMISSION MADE BY ME ON THIS APPLICATION WILL BE SUFFICIENT CAUSE FOR CANCELLATION OF THIS APPLICATION OR IMMEDIATE TERMINATION OF EMPLOYMENT IF I AM EMPLOYED, WHENEVER IT MAY BE DISCOVERED.

AT WILL EMPLOYMENT: I acknowledge that if hired, I am an at-will employee and I will be subject to dismissal or discipline without notice or cause, at the discretion of the employer. If I am employed, I acknowledge that there is no specified length of employment and that this application does not constitute an agreement or contract for employment. Accordingly, either the employer or I can terminate the relationship at will, with or without cause, at any time, so long as there is no violation of applicable federal or state law.

I understand that it is the policy of this organization not to refuse to hire or otherwise discriminate against a qualified individual with a disability because of that persons need for a reasonable accommodation as required by the ADA.

I also understand that if I am employed, I will be required to provide satisfactory proof of identity and legal work authorization within three days of being hired. Failure to submit such proof within the required time shall result in immediate termination of employment.

I represent and warrant that I have read and fully understand the foregoing, and that I seek employment under these conditions.

DIRECT DEPOSIT NOTICE: Please note that we do not do payroll on site, it is done by a payroll service, we do not write checks for payroll so you must have a bank account, a debit card or Wal-Mart sells Green Dot cards that several employees purchase. Please make sure Human Resources has your routing number and account number for deposit.