Employment Application
Fill the form below accurately indicating your potentials and suitability to job applying for.
General Information
Name
*
First Name
Middle Name
Last Name
Suffix
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Are you 16 or older?
Yes
No
Email
example@example.com
Phone Number
*
How were you referred to us?
*
Walk-In
Referral
Newspaper Ad
Facebook
Twitter
LinkedIn
Other (please specify)
Upload Resume if Applicable
Upload a File
Drag and drop files here
Choose a file
Cancel
of
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Employment Desired
Position
Status
Full-Time
Part-Time
Any
Salary Desired
When Can You Start?
-
Month
-
Day
Year
Date
Are you currently employed?
Yes
No
May we inquire of your present employer?
Yes
No
Preferred Work Location
Amery, WI
Clear Lake, WI
Hammond, WI
Any Location
Training and Certifications
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Education
Elementary School
Information listed below is in correlation to attending Elementary School
Did you attend Elementary School?
Yes
No
Elementary School Information
High School
Information listed below is in correlation to attending High School
Did you attend High School?
Yes
No
High School Information
College
Information listed below is in correlation to attending High School
Did you attend College?
Yes
No
College Information
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Former Employers
List below your last four employers, starting with the last one first
Employer 1
Start Date
-
Month
-
Day
Year
Date
End Date
-
Month
-
Day
Year
Date
Employer Information
Employer Name
Street Address
City
State / Province
Postal / Zip Code
Salary upon leaving
Position
Reason for Leaving
Employer 2
Start Date
-
Month
-
Day
Year
Date
End Date
-
Month
-
Day
Year
Date
Employer Information
Employer Name
Street Address
City
State / Province
Postal / Zip Code
Salary upon leaving
Position
Reason for Leaving
Employer 3
Start Date
-
Month
-
Day
Year
Date
End Date
-
Month
-
Day
Year
Date
Employer Information
Employer Name
Street Address
City
State / Province
Postal / Zip Code
Salary upon leaving
Position
Reason for Leaving
Employer 4
Start Date
-
Month
-
Day
Year
Date
End Date
-
Month
-
Day
Year
Date
Employer Information
Employer Name
Street Address
City
State / Province
Postal / Zip Code
Salary upon leaving
Position
Reason for Leaving
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References
Please list two (2) references that are familiar with your work life.
Reference
Reference
Do you have any friends or relatives who are now employed by this company?
Yes
No
Please state names and their relationship to you
If you are to be hired by the company, you will be required to attest to your identity and employment eligibility, and to present documents confirming your identity and employment eligibility. You cannot be hired if you cannot comply with these requirements.
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Authorization
I certify that the facts contained in this application (and accompanying resume ,if any) are true and complete to the best of my knowledge. I understand that any false statement, omission, or misrepresentation on this application is sufficient cause for refusal to hire, or dismissal if I have been employed, no matter when discovered by the Company. I understand that any employment is conditioned on a background check. I authorize the Company to thoroughly investigate all statements contained in my application or resume, and I authorize my former employers and references to disclose information regarding my former employment, character and general reputation to the Company, without giving me prior notice of such disclosure. In addition, I release the Company, any former employers and all references listed above from any and all claims ,demands or liabilities arising out of or related to such investigation or disclosure. I understand and agree that nothing contained in this application, or conveyed during any interview, is intended to create an employment contract. I further understand and agree that if I am hired, my employment will be “at will” and without fixed term, and may be terminated at any time, with or without cause and without prior notice, at the option of either myself or the Company. No promises regarding employment have been made to me, and I understand that no such promise or guarantee is binding upon the Company unless made inwriting. If I am offered employment I agree to submit to a medical examination and drug test before starting work. If employed, I also agree to submit to a medical examination or drug test at any time deemed appropriate by the Company and as permitted by law. I consent to such examinations and tests, and I request that the examining doctor disclose to the Company the results of the examination, which results shall remain confidential and segregated from my personnel file. I understand that my employment or continued employment, to the extent permitted by law, is contingent upon satisfactory medical examinations and drug test, and if I am hired a condition of my employment will be that I abide by the Company’s Drug and Alcohol Policy. I understand that filling out this form does not indicate there is a position open and does not obligate the Company to hire. If hired, I agree to abide by all Company work rules, policies and procedures. The Company retains the right to revise its policies or procedures, in whole or in part, at any time
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