Application for Employment Our policy is give preference first to Guardsmen, Reservists and honorably discharged military veterans, then to provide equal employment opportunity to all qualified persons who have demonstrated they understand the concept of personal responsibility, without regard to race, creed, color, religious belief, gender, age, national origin, or ancestry. Date ______________ Last name ________________________ First name ________________ Middle name________ Street Address ____________________________________________________________________ City _____________________ State _______ ZIP _______ Telephone ___________________________ Social Security # ___________________________ Position applied for ______________________________________________________________ How did you hear of this opening? _________________________________________________ When can you start? _____________________ Desired Wage $______________ Are you a U.S. citizen or otherwise authorized to work in the U.S. on an unrestricted basis? (You may be required to provide documentation.)  Yes  No Are you looking for full-time employment?  Yes  No If no, what hours are you available? ______________ Are you willing to work swing shift?  Yes  No Are you willing to work graveyard?  Yes  No Have you ever been convicted of a felony? (This will not necessarily affect your application.)  Yes  No If yes, please describe conditions. __________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ Education School Name and Location Year Major Degree High School ________________________________________ ______ ______ ______ College ___________________________________________ ______ ______ ______ College ___________________________________________ ______ ______ ______ Post-College _______________________________________ ______ ______ ______ Other Training ______________________________________ ______ ______ ______ In addition to your work history, are there other skills, qualifications, or experience that we should consider? ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ Employment History (Start with most recent employer) Company Name ________________________________________________________________ Address ____________________________________ Telephone ______________________ Date Started ___________ Starting Wage ____________ Starting Position ________________ Date Ended _____________ Ending Wage ____________ Ending Position ________________ Name of Supervisor ____________________________________ May we contact?  Yes  No Responsibilities _____________________________________________________________ ______________________________________________________________________________ Reason for leaving ___________________________________________________________ Company Name ________________________________________________________________ Address ____________________________________ Telephone ______________________ Date Started ___________ Starting Wage ____________ Starting Position ________________ Date Ended _____________ Ending Wage ____________ Ending Position ________________ Name of Supervisor ____________________________________ May we contact?  Yes  No Responsibilities _____________________________________________________________ ______________________________________________________________________________ Reason for leaving ___________________________________________________________ Company Name ________________________________________________________________ Address ____________________________________ Telephone ______________________ Date Started ___________ Starting Wage ____________ Starting Position ________________ Date Ended _____________ Ending Wage ____________ Ending Position ________________ Name of Supervisor ____________________________________ May we contact?  Yes  No Responsibilities _____________________________________________________________ ______________________________________________________________________________ Reason for leaving ___________________________________________________________ Company Name ________________________________________________________________ Address ____________________________________ Telephone ______________________ Date Started ___________ Starting Wage ____________ Starting Position ________________ Date Ended _____________ Ending Wage ____________ Ending Position ________________ Name of Supervisor ____________________________________ May we contact?  Yes  No Responsibilities _____________________________________________________________ ______________________________________________________________________________ Reason for leaving ___________________________________________________________ Attach additional information if necessary. I certify that the facts set forth in this application for employment are true and complete to the best of my knowledge. I understand that if I am employed, false statements on this application shall be considered sufficient cause for dismissal. This company is hereby authorized to make any investigations of my prior educational and employment history. I understand that employment at this company is “at will,” which means that either I or this company can terminate the employment relationship at any time, with or without prior notice, and for any reason not prohibited by statute. All employment is continued on that basis. I understand that no supervisor, manager, or executive of this company, other than the president, has any authority to alter the foregoing. Signature_______________________________________________ Date _________________