Name

Address

Email Address

Phone Number

Are you eligible to work in the U.S? Are you eligible to work in the U.S? Yes No

Are you at least 18 years or older? (If no, you may be required to provide authorization to work.) Are you at least 18 years or older? (If no, you may be required to provide authorization to work.) Yes No

Have you ever been terminated from employment or asked to resign by an employer? Have you ever been terminated from employment or asked to resign by an employer? Yes No

If yes, please provide company names and details

What shift are you available for?

Can you work any shift? Can you work any shift? Yes No

Can you work overtime, including weekends? Can you work overtime, including weekends? Yes No

Do you have reliable transportation?

Are you able to perform the essential functions of the job for which you are applying, with or without a reasonable accommodation? Are you able to perform the essential functions of the job for which you are applying, with or without a reasonable accommodation? Yes No

Date you can start

Hourly Rate/Salary desired

Position desired

Are you currently employed?

If so may we inquire of your present employer?

Have you been referred by a current Team Member?

If yes, list name of Team member

Have you ever worked for this company before? Explain.

Do you know anyone who works for our company? Do you know anyone who works for our company? Yes No

If yes, who?

Education and Training - High School: List name of school, years attended, did you graduate, subject/major

Education and Training - College: List name of school, years attended, did you graduate, subject/major

Education and Training - Special Training: List name of school, years attended, did you graduate, subject/major

Education and Training - Certificate or Other: List name of school, years attended, did you graduate, subject/major

EMPLOYMENT HISTORY: Include to and from dates (month/year), employer name and phone number, salary start and end, position held/responsibilities, reason for leaving

EMPLOYMENT HISTORY: Include to and from dates (month/year), employer name and phone number, salary start and end, position held/responsibilities, reason for leaving

EMPLOYMENT HISTORY: Include to and from dates (month/year), employer name and phone number, salary start and end, position held/responsibilities, reason for leaving

EMPLOYMENT HISTORY: Include to and from dates (month/year), employer name and phone number, salary start and end, position held/responsibilities, reason for leaving

Do you have any specific skills, experience and/or training that would enhance your ability to perform the position applied for? If yes, explain.

Relevant Skills (I.E.) HI-LO, Lock Out Tag Out – Confined Space etc. (Please provide a listing and explanation of any relevant skills or training.)

Do you have US Military Experience? Do you have US Military Experience? Yes No

Date Entered

Branch

Rank

Date Discharged

Honorably?

Have you ever been convicted of a felony (crime) or do you have felony (crime) charges that are pending

If so, please state citation, date and place where offence occurred

REFERENCES (Give the name of a person not related to you, whom you have known at least three (3) years.) - list name, phone number, relationship, years known

REFERENCES (Give the name of a person not related to you, whom you have known at least three (3) years.) - list name, phone number, relationship, years known

REFERENCES (Give the name of a person not related to you, whom you have known at least three (3) years.) - list name, phone number, relationship, years known