Career Form Fill The Application Fill The Application Step 1 of 3 33% Answer each question fully and accurately. No action can be taken on this application until you have answered all questions. Use blank paper if you do not have enough room on this application. PLEASE PRINT, except for signature on back of application. In reading and answering the following questions, be aware that none of the questions are intended to imply illegal preferences or discrimination based upon non-job-related information. Job Applied for*Today’s Date*Are you seeking employment:*Full-timePart-timeTemporaryWhen could you start work?*Last Name*First Name*Middle Name*Telephone Number*Present Street Address*Are you 18 years of age or older?*YesNo(If you are hired, you may be required to submit proof of age.)Social Security #If hired, can you furnish proof you are eligible to work in the U.S.?*YesNoHave you ever applied here before?*YesNoWere you ever employed here?*YesNoHave you ever been convicted of any law violation? Include any plea of “guilty” or “no contest.” Exclude minor traffic violations.)*YesNoIf yes, give detailsIf employed, do you expect to be engaged in any additional business or employment outside of our job?.*YesNoIf yes, give detailsFor Driving Jobs Only: Do you have a valid driver’s license?*YesNoHave you had your driver’s license suspended or revoked in the last 3 years?*YesNoList professional, trade, business or civic activities and offices held. (Exclude labor organizations and memberships which reveal race, color, religion, national origin, sex, age, disability or other protected status.)LIST NAME AND ADDRESS OF SCHOOLS High School or GED:College or University:Vocational or Technical:What skills or additional training do you have that relate to the job for which you are applying?*What machines or equipment can you operate that relate to the job for which you are applying?* List names of employers in consecutive order with present or last employer listed first. Account for all periods of time including military service and any periods of unemployment. if self-employed, give firm name and supply business references. Note: A job offer may be contingent upon acceptable references from current and former employers. ******* Date Format: MM slash DD slash YYYY DATES OF EMPLOYMENT (MO/YR): * Date Format: MM slash DD slash YYYY *** Date Format: MM slash DD slash YYYY DATES OF EMPLOYMENT (MO/YR): Date Format: MM slash DD slash YYYY Date Format: MM slash DD slash YYYY DATES OF EMPLOYMENT (MO/YR): Date Format: MM slash DD slash YYYY Date Format: MM slash DD slash YYYY DATES OF EMPLOYMENT (MO/YR): Date Format: MM slash DD slash YYYY Have you worked or attended school under any other names?*YesNoIf yes, give names:Are you presently employed?*YesNoIf yes, whom do you suggest we contact?Have you ever been fired from a job or asked to resign?*YesNoIf yes, please explain:Give three references, not relatives or former employers.* PLEASE READ EACH STATEMENT CAREFULLY BEFORE SIGNING I certify that all information provided in this employment application is true and complete. I understand that any false information or omission may disqualify me from further consideration for employment and may result in my dismissal if discovered at a later date. I authorize the investigation of any or all statements contained in this application. I also authorize, whether listed or not, any person, school, current employer, past employers and organizations to provide relevant information and opinions that may be useful in making a hiring decision. I release such persons and organizations from any legal liability in making such statements. I understand I may be required to successfully pass a drug screening examination. I hereby consent to a pre- and/or post-employment drug screen as a condition of employment, if required. I understand that if I am extended an offer of employment it may be conditioned upon my successfully passing a complete pre-employment physical examination. I consent to the release of any or all medical information as may be deemed necessary to judge my capability to do the work for which I am applying. I UNDERSTAND THAT THIS APPLICATION, VERBAL STATEMENTS BY MANAGEMENT, OR SUBSEQUENT EMPLOYMENT DOES NOT CREATE AN EXPRESS OR IMPLIED CONTRACT OF EMPLOYMENT NOR GUARANTEE EMPLOYMENT FOR ANY DEFINITE PERIOD OF TIME. ONLY THE PRESIDENT OF THE ORGANIZATION HAS THE AUTHORITY TO ENTER INTO AN AGREEMENT OF EMPLOYMENT FOR ANY SPECIFIED PERIOD AND SUCH AGREEMENT MUST BE IN WRITING, SIGNED BY THE PRESIDENT AND THE EMPLOYEE. IF EMPLOYED, I UNDERSTAND THAT I HAVE BEEN HIRED AT THE WILL OF THE EMPLOYER AND MY EMPLOYMENT MAY BE TERMINATED AT ANY TIME, WITH OR WITHOUT REASON AND WITH OR WITHOUT NOTICE. I have read, understand, and by my signature consent to these statements. Signature:*This application for employment will remain active for a limited time. Ask the organization’s representative for details.Date Date Format: MM slash DD slash YYYY APPLICANT AFFIRMATIVE ACTION INFORMATION It is the policy of this organization to provide equal employment opportunity to all qualified applicants for employment without regard to race, color, religion, national origin, sex, age, veteran status or disability. COMPLETION OF THIS FORM IS VOLUNTARY AND IN NO WAY AFFECTS THE DECISION REGARDING YOUR APPLICATION FOR EMPLOYMENT. THIS FORM IS CONFIDENTIAL AND WILL BE MAINTAINED SEPARATELY FROM YOUR APPLICATION FORM.Name:***Date* Date Format: MM slash DD slash YYYY Position applied for*Where did you hear about this job?* Racial origin (You may mark one or more of the following): White—A person having origins in any of the original peoples of Europe, the Middle East, or North Africa. American Indian or Alaska Native—A person having origins in any of the original peoples of North and South America (including Central America), and who maintains tribal affiliation or community attachment. Black or African American—A person having origins in any of the black racial groups of Africa. Asian—A person having origins in any of the original peoples of the Far East, Southeast Asia, or the Indian subcontinent including, for example, Cambodia, China, India, Japan, Korea, Malaysia, Pakistan, the Philippine Islands, Thailand, and Vietnam. Native Hawaiian or Other Pacific Islander—A person having origins in any of the original peoples of Hawaii, Guam, Samoa, or other Pacific Islands. Ethnicity: Hispanic or Latino—A person of Cuban, Mexican, Puerto Rican, South or Central American, or other Spanish culture or origin, regardless of race. Sex:*MaleFemale I elect not to identify Signature:*This application for employment will remain active for a limited time. Ask the organization’s representative for details.