Name *

First Name

Last Name

Date you can start work? *

MM

DD

YYYY

Do you have a High School Diploma or GED? *

Yes

No

Hours

Full Time

Part Time

Days

Evenings

Swing

Graveyard

Weekends

Status

Regular

Temporary

Are you authorized to work in the U.S. on an Unrestricted Basis?

Yes

No

Have you ever been convicted of a felony? *

(Convictions will not necessarily disqualify an applicant for employment.)

Yes

No

Have you been told the essential functions of the job or have you been viewed a copy of the job description listing the essential functions of the job?

Yes

No

Can you perform these essential functions of the job with or without reasonable accommodation?

Yes

No

Starting Date

MM

DD

YYYY

Starting Date

MM

DD

YYYY

Starting Date

MM

DD

YYYY

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, omissions or misrepresentations may result in my dismissal. I authorize the Employer to make an investigation of any of the facts set forth in this application and release the Employer from any liability. The Employer may contact any listed references on this application. I acknowledge and understand that the company is an "at will" employer. Therefore, any employee (regular, temporary, or other type of category employee) may resign at any time, just as the employer may terminate the employment relationship with any employee at any time, with or without cause, with or without notice to the other party. *

I certify & acknowledge the statements above.