Meloon - Employment Application

Full Name (Required)*

Phone (Required)*

Please enter a valid phone number.

Address

Street Address

Street Address Line 2

CityState

Zip Code

Are you 18 years old or older?

YesNo

Type of work desired

If hired, can you provide proof of your eligibility to work in the United States?

YesNo

Apart from absence for religious observance, are you available for full-time work?

YesNo

If not, what hours can you work?

Hour Minutes

AM/PM Option

Until

until

Hour Minutes

AM/PM Option

Will you work overtime if asked?

YesNo

What date will you be available for work?

Date

Are you able to lift up to 50 pounds on a regular basis, as required by the essential functions of the

YesNo

Experience

	Dates Employed (From-To)	Employer and Location	Type of Work	Supervisor

We may contact the employers listed above unless you indicate those you do not want us to contact. If you wish us to not contact your prior employers, please list the employer below.

Do not contact

What is the reason?

Education

	Name of School and Address	Circle Last Year Completed	Did you Graduate?	Course of Study or Degree
High School
College
Other

Additional Skills/Training (machines, computer knowledge, etc.)

Personal References (Not Relatives)

	Name and Occupation	Telephone Number

Emergency Contact

Telephone

Please enter a valid phone number.

I hereby certify that the above statements are true. Should any information be false, I understand that this is sufficient case for dismissal. Should I be accepted for employment, I agree to comply with all company rules and regulations, to learn my work thoroughly and to take every precaution so that I will not cause injury to myself or to my fellow workers. I understand that acceptance of an offer of employment does not create a contractual obligation upon the Employer to employ me in the future.

All new hires will be placed on a 90-day probationary period and must successfully pass a drug test and a placement physical examination prior to be eligible for regular employment.

Signature

Date

Please verify that you are human*