First Name:
Middle Name:
Last Name:
Mailing Address:
City:
State:
Zip Code:
Are you over the age of 21?:
Yes No
Are you under the age of 18?:
Yes No
Are any of your relatives presently employed with the Company?:
Yes No
Have you previously applied for employment with us?:
Yes No
Have you ever been employed by us?:
Yes No
Position Applied For:
Can you perform the essential functions of the job applied for, with or without accomodation?:
Yes No
Availability:
(check all that apply)
Full Time Part Time
Dates and Hours Available:
Mon: to
Tue: to
Wed: to
Thu: to
Fri: to
Sat: to
Sun: to
High School Education:
Name and Location:
Course of Study:
Years Completed:
Diploma/Degree:
Additional College Education:
Name and Location:
Course of Study:
Years Completed:
Diploma/Degree:
Have you ever been convicted of a crime?:
Yes No
If yes, please explain and give dates:
Most Recent Employment:
Company:
Telephone:
--
Job title & duties performed:
Dates of Employment:
to
Weekly Pay:
Reason for Leaving:
Previous Employment:
Company:
Telephone:
--
Job title & duties performed:
Dates of Employment:
to
Weekly Pay:
Reason for Leaving:
Previous Employment:
Company:
Telephone:
--
Job title & duties performed:
Dates of Employment:
to
Weekly Pay:
Reason for Leaving:
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Home Phone Number:
--
Cell Phone Number:
--
Email Address:
Social Security Number:
Please indicate any special qualifications or skills that you can bring to this company:
Within three days of employment, can you submit documentation verifying that you are legally eligible to work in the United States (Verification required by law)?
Yes No
Yes, I would like to receive email announcements about upcoming acts and special offers.
Preferred Email Format:
HTML Plain Text
Date you can start work:
Desired Wage:
Are you currently employed?:
Yes No
If hired, will you work overtime if required?:
Yes No
College Education:
Name and Location:
Course of Study:
Years Completed:
Diploma/Degree:
Other Education:
Name and Location:
Course of Study:
Years Completed:
Diploma/Degree:
Military Service:
Branch of Service:
Dates of Service:
to
Rank at Discharge:
Date of Discharge:
First Personal Reference:
Name:
Address:
Years Known:
Telephone:
--
Second Personal Reference:
Name:
Address:
Years Known:
Telephone:
--
Third Personal Reference:
Name:
Address:
Years Known:
Telephone:
--
By submitting this form, I certify that I have read and fully understand the questions asked in this application. I authorize the Company to investigate all matters contained in this application. I certify that all statements in this application are true and complete to the best of my knowledge and belief. I understand and agree that if anything in this application is false, or if the results of the Company's investigation are not satisfactory, any offer of employment made may be withdrawn, or my employment terminated immediately without any obligation or liability to me, except for payment for services actually performed if any.
I authorize third parties including individuals, schools, companies, redit bureaus, former employers, law enforcement agencies, corporations and other organizations to supply information about my background to the Company and I release them from all liability for doing so.
I further understand and agree that, if hired, my employment always will be at-will. Either the Company or I can end my employment at any ime, with or without cause, and without prior notice. This at-will employmment relationship will remain in effect unless it is specifically modified by an express written Employment Agreement signed by the Chief Executive Officer of the Company or by an applicable collevtive bargaining agreement. I understand and agree that this at-will employment relationship may not be modified by any oral statement or implied agreement.
I understand that as a condition of employment, Iwill voluntarily and successfully complete substance abuse screening except as prohibited by law (we are a drug-free workplace), a background investigation, reference check, and a pre-employment physical (if required).
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