Honey's Support Employment Application

Date

Full Name

Social Security #

Address

Present Address

Street Address Line 2

CityState

Zip

Phone Number

Please enter a valid phone number.

If you are under 18, can you furnish a work permit?

YesNo

Employment Desired?

Full TimePart TimeTempSeasonal

Position

Date you can start

Date

Salary

Are you employed now?

If so, May we inquire of your present employer?

YesNo

Have you ever applied to this company before?

YesNo

If so, Where

If so, When

Are you on layoff and subject to recall?

YesNo

Are you willing to travel if required?

YesNo

Will you relocate if job requires?

YesNo

Are you willing to work overtime if needed?

YesNo

Are you able to meet the attendance requirements of this position?

YesNo

Have you ever been bonded?

YesNo

Have you ever been convicted of a felony in the past 7 years?

YesNo

Such conviction may be relavent if it is job related, but does not bar you from employment. If you answered yes, please explain.

Driver's License Number

State

Type a question

	Name & Location of School	# of Years Completed	Date of Graduation	Subject Studied
Currently Attending
Last Completed

Summarize special skills and qualifications acquired from employment or other experiences that may qualify you to work with this company.

Type a question

	Name of Employer	Date Worked (From - To)	Salary	Job	Reason For Leaving
Most Recent Employer
Previous Employer
Previous Employer

References: Give the names of three persons not related to you to whom you have known at least 1 year

References

	Address	Phone	Years Acquainted
Name
Name
Name

In case of emergency, who would be your emergency contact?

Name

Address

Relationship

Phone

Conditions of Employment - please read carefully Reporting to work with impaired abilities; or the possession, consumption or distribution of drugs or alcohol on company premises and/or worksites, shall be grounds for disciplinary action, including discharge. A condition of employment includes willingness on the part of the applicant or employee to agree to physical examination. polygraph and/or substance testing, if required by the company. We are committed to operating a drug free workplace. Violations of our drug and alcohol policy will result in dismissal.

Reporting to work with impaired abilities; or the possession, consumption or of drugs or alcohol on company premises and/or worksites, shall be grounds disciplinary action, including discharge. A condition of employment includes on the part of the applicant or employee to agree to physical examination. and/or substance testing, if required by the company. We are committed to a drug free workplace. Violations of our drug and alcohol policy will result in

It is understood and agreed upon that any misrepresentation by me in this application will be sufficient cause for cancellation of this application and/or separation from the employer's service if I have been employed. Furthermore, I understand that just as I am free to resign anytime, the Employer reserves the right to terminate my employment at any time, with or without cause and without prior notice. I understand that no representative of the Employer has the authority to make any assurances to the contrary.

I give the employer the right to investigate all police. driving, and personal records references, if job related. I hereby release from liability the Employer and its representatives for seeking such information and all other persons, corporations or organizations for furnishing such information.

The Employer is an Equal Opportunity Employer. The Employer does not discriminate in employment and no question on this application is used for the purpose of or excusing any applicant's consideration for employment on a basis prohibited local, State or Federal law.

Any controversy of any kind arising between the parties under this agreement or (or any agent. officer, director or affiliate of any party). including but not to common law, statutory. tort or contract claims, will be submitted to mediation failing settlement in mediation, to binding arbitration. Unless otherwise agreed a mediation and arbitration designated by staff professionals will govern any mediation arbitration. The parties will select the mediator or arbitrator from the designated panel of mediators and will notify the designated company. in writing, to the selection process. The arbitration will be subject to and governed by the provisions of the Federal Arbitration Act. 9 U.S.C. Section 1 et seq. The parties hereto that this agreement involves matters affecting interstate commerce.

This application is current for 60 days. At the conclusion of this time if I have not from the Employer and still wish to be considered for employment, it will be to fill out a new application.

Signature of Applicant

Date

AGENCY MANAGEMENT NOTES

Honey's Support

APPLICATION FOR EMPLOYMENT

INITIAL