Application for Employment

Position title*

Employment desired:*

Full timePart time

Available start date*

Date

Have you ever applied to work here before? yes or no If yes, provide date Date and position:
job title

Have you ever worked here before?yes or no . If yes, provide date Date and position: job title .

Are you currently employed?*

YesNo

If yes, may we contact your employer?*

YesNo

Are you authorized to work in the United States? (Proof of citizenship or immigration status may be required upon employment)*

YesNo

If under 18, can you provide a work permit?*

YesNo

Have you ever been convicted of a crime?yes or no field. If yes, what was the date? Date and what was the crime? job title .

Can you travel if the job requires it?*

YesNo

Are you able to lift a 50-pound or more weight and carry it 100 yards, as that is part of the job?*

YesNo

Based on the job description, are you able to perform the essential functions of this job with or without reasonable accommodations?*

YesNo

Resume

Browse Files

Upload a resume here, alternatively, type or paste into the text field below.

Resume

Cover letter

Browse Files

Upload a personal introduction here, alternatively, type or paste into the text field below.

Cover Letter

Please list three references*

Rows	Name	Relation to you	Phone	Email	Job title	Company
Reference 1
Reference 2
Reference 3

WAIVERS AND DISCLOSURES

Please read each section carefully and sign where indicated.

NON-DISCRIMINATION POLICY:

Chaos Fab Shop L.LC. is committed to the principle of equal opportunity in education and employment. Chaos Fab Shop L.LC. does not discriminate on the basis of sex, race, color, creed, national origin, age, religion, sexual orientation, gender identity, gender expression, veteran status, or disability in admission to, access to, treatment in, or employment in its programs and activities.

The following person has been designated to handle inquiries regarding Chaos Fab Shop L.LC.’s nondiscrimination policies: Owner, Maria Whatley, Chaos Fab Shop L.L.C. 344 Victory Rd., Winchester, VA 22602.

AT-WILL EMPLOYMENT:

It is my understanding that this employment application, or the granting of an oral interview, does not represent a contract of employment or a promise of future benefits by this organization. I understand and agree that, if hired, my employment will be at-will in nature and may be terminated, with or without cause, at any time, by either myself or my employer. I also understand that this written statement supersedes any and all oral representations made by agents or representatives of this organization.

CERTIFICATION OF TRUTH AND ACCURACY:

I certify that the information in this application is true, complete and correct. I understand that false answers, statements, or significant omissions made by me on this form shall be sufficient cause for denial of employment or discharge.

NOTIFICATION AND AUTHORIZATION TO CONDUCT BACKGROUND INVESTIGATION:
I understand that I may be subject to a background check, and hereby authorize Chaos Fab Shop L.LC. or its agent, employee, or contractor to investigate my background to determine any and all information of concern as to my record, whether same is of record or not, and I release employers and persons named in my application from all liability for any damages on account of his/her furnishing said information.

Additionally, Chaos Fab Shop L.LC. or its agent, employee, or contractor is hereby authorized to make any investigation of my personal history, educational background, military record, motor vehicle records, criminal records and credit history through an investigative or credit agency or bureau of their choice. I authorize the release of this information by the appropriate agencies to the investigating service. This authorization, in original or copy form, shall be valid for this and for any future reports and updates that may be required.

I understand that passing the background check is a condition of employment. A negative background check can be grounds for dismissal, even if an offer has been made to me and I have been hired.

By signing and submitting this form, I acknowledge that I have read, understood, and I agree to Chaos Visitor Guidelines, Waiver of Liability, Modification Liability Release and Agreements.

Please verify that you are human*

Signature*