Application for Employment
Bluestem Hollow is an Equal Opportunity Employer.
Date
*
-
Month
-
Day
Year
Date
Name
*
First Name
Last Name
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email
*
example@example.com
Are you over the age of 18?
*
Yes
No
If you're under the age of 18, what is your birth date?
-
Month
-
Day
Year
Date
Have you ever been convicted of a felony?
*
Yes
No
You might be required to lift 30 lbs. Are you able to perform this task without reasonable accommodation?
*
Yes
No
What is your desired pay rate per hour?
What is your availability?
Rows
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
AM
PM
Not available this day
Open Availability
When are you available to start work?
*
The person that would flourish in this position would be a natural leader, a problem solver, adaptable to every situation and they should be able to work swiftly in a fast-paced environment. Please list any special skills that might be beneficial for this position:
*
It is imperative that associates are available on the weekends.
*
Personal References
Please give two personal references of people not related to you.
1st Reference
*
First Name
Last Name
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Relation to you
*
2nd Reference
*
First Name
Last Name
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Relation to you
*
Previous Work Experience
Start with most recent
Name of Previous Employer
Address of Previous Employer
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Supervisor’s Name
First Name
Last Name
Are we able to contact this supervisor?
Yes
No
Dates of Employment
Salary
Duties
Reason for leaving
Name of Previous Employer
Address of Previous Employer
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Supervisor’s Name
First Name
Last Name
Are we able to contact this supervisor?
Yes
No
Dates of Employment
Salary
Duties
Reason for leaving
Name of Previous Employer
Address of Previous Employer
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Supervisor’s Name
First Name
Last Name
Are we able to contact this supervisor?
Yes
No
Dates of Employment
Salary
Duties
Reason for leaving
If you have any connections to the team at Bluestem Hollow who can recommend you as an employee, please put their names here:
I certify that the facts set forth on this application and true to the best of my knowledge.
Continue
Continue
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