Gross Alaska - Employment Form NEW

Each applicant will be given employment consideration based on individual merit, without regard to the individual's race, color, religion, sex, national origin, the presence of non-job related medical condition, handicap, or other categories governed by applicable law. We are an equal opportunity employer.
Personal Information
Full Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Phone Number*

Area CodePhone Number
E-mail*
Are you at least 16 years of age?*

YesNo
Applicants under the age of 17 MUST have an Alaska State Work Permit.
Reference
Date Available*

MonthDayYear
Hours per week available?*
Able to work weekends?*

YesNo
Do you have transportation?*

YesNo
Worked here before?*

YesNo
Related to anyone here?*

YesNo
Emergency Contact
Name
Relationship
Phone Number

Area CodePhone Number
Employment History

List your last three employers, begin with current or most current
Employer
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
From
To
Position
Reason for leaving
Starting Salary
Ending Salary
Employer
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
From
To
Position
Reason for leaving
Starting Salary
Ending Salary
Employer
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
From
To
Position
Reason for leaving
Starting Salary
Ending Salary
Personal Data
Special qualifications you have - specialized training and/or experience
Military Experience - dates of service, branch, job title, rank, type of discharge
Specific computer skills - programs, applications, etc.
Hobbies, Areas of interest
Education
High School
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
From
To
Graduated / Diploma / Degree?
College/University
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
From
To
Graduated / Diploma / Degree?
Trade/Technical
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
From
To
Graduated / Diploma / Degree?
List any areas of special study in school
Personal References

List the names of three persons not related to you who have known you for at least two years
Full Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*

Area CodePhone Number
Relationship*
Years Known*
Full Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*

Area CodePhone Number
Relationship*
Years Known*
Full Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*

Area CodePhone Number
Relationship*
Years Known*
Applicant's Statement

Please read this section carefully before signing
I certify that the information contained in this application is correct to the best of my knowledge and understand that falsification of this information is grounds for refusal to hire, or if hired, dismissal. I authorize investigation of all statements contained in this application. I understand that this application is not intended to be a contract of employment. I understand and agree that my employment is for no specific period of time and may be terminated at any time without previous notice.

JUNEAU APPLICANTS ONLY; I understand that Gross-Alaska enforces a dress code of dress black slacks and an approved white dress shirt which I am required to provide or purchase. I also understand Gross-Alaska will provide a vest and a bow tie as part of the dress code which are the property of Gross-Alaska.
I agree to the terms above*

YesNo
Are you willing to take a pre-employment substance abuse test*

YesNo
Should be Empty:

Personal Information

Reference

Employment History

Personal Data

Education

Personal References

Applicant's Statement