Application for Employment

Application for Employment

It is our policy to comply with all applicable state and federal laws prohibiting discrimination in employment based on race, age, color, sex, religion, national origin, disability or other protected classifications.
Position Applying For:*
Please select position type:*
Name:*

First NameMiddle NameLast NameSuffix
Address:*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number:*
Please enter a valid phone number.
Email Address:*
example@example.com
Social Security Number:*
EX.: 000-00-0000
Are you able to perform the essential functions of this position with or without accommodations?*
Are you at least 18 years of age?*
Are you legally eligible for employment in the U.S.?*
Please indicate the days that you are available to work:*
Please indicate the hours that you are available to work:*
Have you ever been convicted of a crime (felony or misdemeanor) other than a minor traffic violation?*
If yes to previous question, please explain:
Are you willing and able to work overtime?*
Are you willing to work during holidays?*
Are you able to provide a valid Driver's License?*
If yes to previous question, please provide a copy of a government issued ID.*

Acceptable forms of ID's: Driver's License, Military ID, Passport
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When will you be able to begin work?*
Are you a veteran?*
If yes to previous question, please list duty / specialized training:
Please provide your education & employment history by uploading your resume.*

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Skills & Qualifications*
Other qualifications such as special skills, abilities, or honors that should be considered, including types of computers, software, and other equipment you are qualified to operate or repair.
Please upload and professional licenses, certifications, or registrations.

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Please upload a file that includes three professional references:*

This document must include name, address, telephone, e-mail, occupation, & years known of the professional references.
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NOTICE TO APPLICANT:

I certify that the information contained in this application is true and complete to the best of my knowledge. I understand that falsified statements, misrepresentations, or omissions maybe grounds for dismissal.

I authorize investigation of all statements contained herein and the references listed above to give any and all information concerning my previous employment and any pertinent information they may have, personal or otherwise. I release all parties from all liability for any damage that may result from furnishing this information to you. I understand that I may make a written request for information derived from background and reference checks.

If necessary for employment, you maybe required to: supply your birth certificate or other proof of authorization to work in the United States, have a physical examination and / or drug test, or to sign a conflict of interest agreement and abide by its terms. If hired, employment is for no definite period and maybe terminated at anytime without prior notice. I understand and agree to the information shown above.
Signature of Applicant*

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