• Employment Application Form

    All statements made by applicants for employment on this application form will be carefully checked for accuracy. We offer equal employment opportunities to all persons without regard to race, religion, age, sex, national origin or handicap. The use of this form does not mean there are positions open and does not obligate us in any way. This application will remain on active file for a period of 12 months from the date of the application.
  • Today's Date
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  • How soon could you report to work?
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  • Personal Information

  • Format: (000) 000-0000.
  • Are you over the age of 18? If no, employment is subject to verification that you are of minimum age.*
  • Are you a citizen of the United States?*
  • Are you authorized to work in the United States on an unrestricted basis?*
  • Do you have a valid Kansas Driver's License?*
  • Do you have a good driving record?*
  • Have you ever been convicted of a crime, except for a minor traffic violation?*

  • Education

  • Do you have a high school diploma or GED?*

  • Special Skills

  • Employment History

  • Have you ever applied for a job with us before?*
  • Have you ever worked for us before?*
  • Have you ever been discharged or requested to resign from a position?*
  • Does your current employer know you plan a change of employment?*
  • May we contact them?*
  • Have you ever help a position of trust? (i.e. handling money or confidential material?)*

  • Prior Work History

    Start with your current or most recent employer

  • Applicant Agreement and Certification

    “I certify that the information given by me in this application is true in all aspects and I agree that if employed and it is found to be false in any way, that I may be subject to dismissal without prior notice. I authorize the use of any information in this application to verify my statements and I authorize the past employers and all references to answer all questions asked concerning my ability, character, reputation and previous employment record. I further agree, if employed, that I am to work faithfully and diligently. I will be careful to avoid accidents, to come to work promptly and will not be absent for any reason without prior notice to my supervisor. And that employment is terminable at the will of either employee or employer. I agree to be employed for a probationary period of 30 calendar days and that I may be dismissed at any time during this period at the discretion of the employer. I agree to submit to a physical examination and a drug screening whenever requested. And if employed, I agree to observe and adhere to all personnel policies and rules. I understand this is not a contract of employment and I do not construe it as such.”

  • Date
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  • Should be Empty: