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Employment Application
Please fill out everything completely. If something does not apply, leave blank
PERSONAL INFORMATION
First Name:
Middle Name:
Last Name:
Street:
Street 2:
City:
State:
AL
AK
AZ
AR
CA
CO
CT
DE
FL
GA
HI
ID
IL
IN
IA
KS
KY
LA
ME
MD
MA
MI
MN
MS
MO
MT
NE
NV
NH
NJ
NM
NY
NC
ND
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VT
VA
WA
WV
WI
WY
ZIP/Postal Code:
Email Address:
Phone Number:
Are you at least 18 years old?:
Yes
No
Are you legally eligible to work in the United States?:
Yes
No
Have you ever been convicted of a crime?:
No
Yes, A Misdemeanor
Yes, A Felony
Are you able to stand for up to 8 hours during a shift?:
No
Yes
Are you able to lift up to 70 pounds repetitively?:
No
Yes
We have a strict "no cell phone usage" policy. Cell phones can only be used during breaks and not allowed in work areas. Will you be able to adhere to our strict NO CELL PHONE policy?:
No
Yes
Do you have reliable transportation?:
No
Yes
Do you have a valid drivers license?:
No
Yes
What is your expected hourly pay?:
Please tell us about yourself, in your words, tell us why you would be a great addition to our team:
Please select your employment preference:
Temporary
Part Time
Full Time
How many days per week are you available to work?:
1 day per week
2 days per week
3 days per week
4 days per week
5 days per week
6 days per week
7 days per week
When is the earliest you can start working?:
Immediately
In 1 week
In 2 weeks
In 3 weeks
In 4 weeks
Longer than 4 weeks
HIGH SCHOOL EDUCATION
Select the highest middle or high school grade level you have completed:
9th grade
10th grade
11th grade
12th grade
Do you have a high school diploma or GED?:
No
Yes
High School Name:
High School City:
High School State:
TRADE SCHOOL EDUCATION
Select the number of years you have completed:
0 years
1 year
2 years
3 or more years
Did you earn a certificate?:
No
Yes
Trade School Name:
Trade School City:
Trade School State:
COLLEGE EDUCATION
Select the number of years you have completed:
0 years
1 year
2 years
3 or more years
Select the degree earned:
none
Associates
Bachelors
Masters
College Name:
College City:
College State:
EMPLOYMENT HISTORY 1 (most recent first)
Name Of Employer:
Employer Address:
Employer Phone Number:
Job Title:
Job Description/Duties:
Start Date:
End Date:
Starting Hourly Salary:
Ending Hourly Salary:
Supervisor Name:
Reason For Leaving:
Still Employed
Terminated
Voluntary Leave
Assignment Ended
May We Contact This Employer?:
Yes
No
EMPLOYMENT HISTORY 2
Name Of Employer:
Employer Address:
Employer Phone Number:
Job Title:
Job Description/Duties:
Start Date:
End Date:
Starting Hourly Salary:
Ending Hourly Salary:
Supervisor Name:
Reason For Leaving:
Still Employed
Terminated
Voluntary Leave
Assignment Ended
May We Contact This Employer? 2:
Yes
No
EMPLOYMENT HISTORY 3
Name Of Employer:
Employer Address:
Employer Phone Number:
Job Title:
Job Description/Duties:
Start Date:
End Date:
Starting Hourly Salary:
Ending Hourly Salary:
Supervisor Name:
Reason For Leaving:
Still Employed
Terminated
Voluntary Leave
Assignment Ended
May We Contact This Employer?:
Yes
No
EMPLOYMENT HISTORY 4
Name Of Employer:
Employer Address:
Employer Phone Number:
Job Title:
Job Description/Duties:
Start Date:
End Date:
Starting Hourly Salary:
Ending Hourly Salary:
Supervisor Name:
Reason For Leaving:
Still Employed
Terminated
Voluntary Leave
Assignment Ended
May We Contact This Employer?:
Yes
No
PERSONAL REFERENCE 1
Name:
Phone Number:
Relationship:
Years Acquainted:
City:
State:
May We Contact This Reference?:
Yes
No
PERSONAL REFERENCE 2
Name:
Phone Number:
Relationship:
Years Acquainted:
City:
State:
May We Contact This Reference?:
Yes
No
PERSONAL REFERENCE 3
Name:
Phone Number:
Relationship:
Years Acquainted:
City:
State:
May We Contact This Reference?:
Yes
No
Please include any experience or other relevant information that may help us consider you for this position:
Enter the following code (not case sensitive):