APPLICATION FOR EMPLOYMENT (CA)

APPLICATION FOR EMPLOYMENT (CA)
We appreciate your interest in Company. Company is an equal employment opportunity employer. The Company’s policy is not to discriminate against any applicant or employee based on race, color, sex, sexual orientation, gender identity, religion, national origin, age (40 and over), disability, military status, genetic information or any other basis protected by applicable federal, state, or local laws. Company also prohibits harassment of applicants or employees based on any of these protected categories. It is also Company’s policy to comply with all applicable federal, state and local laws respecting consideration of unemployment status in making hiring decisions.

Applicants with disabilities may be entitled to reasonable accommodation under the Americans with Disabilities Act and certain state or local laws. A reasonable accommodation is a change in the way things are normally done which will ensure an equal employment opportunity without imposing undue hardship on the company. Please inform the company’s personnel representative if you need assistance completing this application or to otherwise participate in the application process.

Your application will be active for 30 days. If you are not hired during that time period, but wish to continue to be considered for available positions, you must complete a new application.

Note to Applicants: Smoking is prohibited in all indoor areas of Company unless designated smoking areas have been established by a particular location in accordance with applicable state and local law.
SUBMISSION OF RESUME:

Please email resume to Coffeeroadah@nva.com
G E N E R A L I NF O R M A T I O N

Please complete all requested information.
Date*

MonthDayYear
Date
Name*

First NameMiddle NameLast Name
Email
example@example.com
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Home Phone Number*

Area CodePhone Number
Work Phone Number

Area CodePhone Number
Position Applying For *
Expecteed salaary/hourly range:*
Applying for:

Full-timePart-timeSeasonal/temporary
Are you at least 18 years old?*

YesNo
Minimum Salary Desired*
Date Available for Work *
Minimum Salary Desired *
Are you available to work overtime as needed?*

YesNo
If yes, are you available weekdays?

YesNo
If yes, are you available weekends?

YesNo
Have you ever used any other name(s) which is (are) necessary for us to know in order for us to verify your employment or educational record?*

YesNo
If yes, pleaseprovide the other name(s):
Have you previously worked for or applied for a position with this Company, in any of our locations either as an employee or through an employment agency?*

YesNo
If yes, please explain when
Are you related to or in a close personal relationship with anyone now employed at this Company? (An answer of “Yes” will not automatically disqualify you from the position for which you are applying.)*

YesNo
If yes, state name(s
P E R M I S S I O N T O W O R K
Are you legally authorized to work in the United States*

YesNo
Will you now or in the future require sponsorship for employment visa status (e.g.H-1B status)? (if hired, Verification will be required consistent with federal law)*

YesNo
R E F E R R A L I N F O R M A T I O N
How did you learnabout us?*

FacebookYellow pagesWebsite/OnlineOther
W O R K E X P E R I E N C E

Please specify your complete full-time and part-time employment history, including self-employment. You may include any verified work performed on a volunteer basis. Begin with your most recent employer. If you require additional space, please use the reverse side of this page and/or the following page.
1. Company Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Supervisor Name

First NameLast Name
Supervisor Phone Number

Area CodePhone Number
Job Title
Work Responsibilities
Start Employed

MonthDayYear
Date
End Employment

MonthDayYear
Date
Reason for Leaving:
2. Company Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Supervisor Name

First NameLast Name
Supervisor Phone Number

Area CodePhone Number
Job Title
Work Responsibilities
Start Employed

MonthDayYear
Date
End Employment

MonthDayYear
Date
Reason for Leaving:
3. Company Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Supervisor Name

First NameLast Name
Supervisor Phone Number

Area CodePhone Number
Job Title
Work Responsibilities
Start Employed

MonthDayYear
Date
End Employment

MonthDayYear
Date
Reason for Leaving:
All employers including your current emplyer may be contacted to verify the information you provided. May we contact your current employer prior to any offer of employment?*

YesNo
BACKGROUND INFORMATION
During the past 7 years, have you ever been discharged, suspended, or asked to resign from any position?*

YesNO
For Purposes of verifying information on this application, have you ever worked or attended school under a differnt name at any of the orginizations you have listed?*

YesNo
P R O F E S S I O N A L R E F E R E N C E S

Individuals not related to you. Business references preferred.
1st References, provide name, occupation, phone, address and years known and capacity
2nd References, provide name, occupation, phone, address and years known and capacity
3rd References, provide name, occupation, phone, address and years known and capacity
E D U C A T I O N & T R A I N I N G

Please include name, street, city, state and zip code for each school.
Graduate (Please include name, street, city, state and zip code for each school)
College (Please include name, street, city, state and zip code for each school)
High School (Please include name, street, city, state and zip code for each school)
Business/Trade/Technical (Please include name, street, city, state and zip code for each school)
JOB-RELATED SKILLS AND QUALIFICATIONS
Please summarize your job-related skills and qualifications:
ADDITIONAL EMPLOYMENT INQUIRIES

If applying for a position that will include driving:
If hired can you provide a valid Drivers license? (if hired, you may be required to provide evidence of insurance or insurability)*

YesNo
Emergency Contact person:*
Phone number of emergency contact:*
A P P L I CA N T ’S S T A T E M E N T & A C K N O W L E D G M E N T

THIS APPLICATION IS NOT COMPLETE UNTIL IT IS FULLY COMPLETED, SIGNED, AND ALL STATEMENTS BELOW HAVE BEEN READ AND .
I certify that all of the information furnished on this application and during the application process is true, complete and correct to the best of my knowledge. I understand that any misrepresentation or omission of facts called for may result in refusal to hire or, if hired, may result in my dismissal at any time regardless of when the false answer or omissions are discovered.*

I understand and acknowledgeOther
I recognize that this employment application is not an offer of employment. I agree that if I am hired by the Company, I will be an at-will employee, meaning that either the Company or I may end the employment relationship at any time with or without cause or notice. I understand that only authorized representatives with explicit authority to enter into agreements, and no manager, supervisor, or other non-authorize representative of the Company, has authority to enter into any agreement for employment for any specified period of time, or to make any agreement contrary to the at-will employment relationship, and with respect to any agreement entered into by the explicitly authorized representative, any such agreements must be in writing and signed by the explicitly authorized representative and by me or my authorized representative. You may contact human resources to inquire as to who the explicitly authorized representative is.*

I understand and acknowledgeOther
I further understand and agree that, except for my at-will employment status, if hired, my wages, hours, working conditions, job assignment(s), and compensation rate(s) will be subject to change by the Company.*

I understand and acknowledgeOther
I understand that if I am offered employment, I may be required to sign anon-solicitation and non-disclosure agreement, as a condition of the employment.*

I understand and acknowledgeOther
I understand that the Company may share the information contained in this application with other Company employees for employment and administrative purposes and hereby consent to such transfer.*

I understand and acknowledgeOther
I hereby authorize, to the extent allowed by applicable federal state and local laws, the Company to conduct its own investigation of my references, employment history and education and, further, authorize the references and prior employers I have listed to disclose to the Company information related to my employment history and qualifications for the position for which I am applying, without giving me prior notice of such disclosure*

I understand and acknowledgeOther
I understand and expressly agree that if employed by the Company, storage areas provided for me (locker, desk, etc.) are open to investigation by the Company without prior notice to me.*

I understand and acknowledgeOther
I agree to undergo a pre-employment physical examination consistent with federal and state law.*

I understand and acknowledgeOther
I agree to submit to legally permissible drug testing upon an offer of employment from the Company and prior to starting work. I agree that any offer of employment is contingent upon my receiving a negative test result.*

I understand and acknowledgeOther
I certify that, if employeed, my employment with the company will not conflict with, or result in the violation of, breach of, or default under, any contract, agreement, or understanding that i am a party to or am bound by, other than those I have disclosed in this application, if any:*

I understand and acknowlegeOther
I agree that, if emplyed, i will report to my supervisor, a representative of HR, or other members of managment., if I am ever harassed by someone in the company or if I ever become aware of any unethical behavior by any employee.*

I uderstand and acknowlegeOther
I wave my rights under California Civil Code 1786.53 to recieve a copy of any public records obtained by the Company to evaluate my application:*

I understand and acknowlegeOther
I understand that the Comapny my not ask or require applicants to disclose past salary, wages or other compensation.*

I understand and acknowledgeOther
A P P L I C A N T ’S S T A T E M E N T & A C K N O W L E D G M E N T (continued)

My signature below certifies that I agree to be bound by the terms and conditions stated in this application, which contains all the understandings between the Company and me concerning the topics addressed herein, and supersedes any prior inconsistent understandings between the Company and me on such issues.
Please verify that you are human*
Date*

MonthDayYear
Date
Signature

Clear
Should be Empty:

APPLICATION FOR EMPLOYMENT (CA)

SUBMISSION OF RESUME:

G E N E R A L I NF O R M A T I O N

P E R M I S S I O N T O W O R K

R E F E R R A L I N F O R M A T I O N

W O R K E X P E R I E N C E

BACKGROUND INFORMATION

P R O F E S S I O N A L R E F E R E N C E S

E D U C A T I O N & T R A I N I N G

JOB-RELATED SKILLS AND QUALIFICATIONS

ADDITIONAL EMPLOYMENT INQUIRIES

A P P L I CA N T ’S S T A T E M E N T & A C K N O W L E D G M E N T

A P P L I C A N T ’S S T A T E M E N T & A C K N O W L E D G M E N T (continued)