Application for Employment

Please print clearly and answer all questions. Resumes are not a substitute for a completed application.

We are an equal opportunity employer. Applicants are considered for positions without regard to race, religion, sex, national origin, age, disability or any other consideration made unlawful by applicable federal, state or local laws.

Name *
Social Security Number			Telephone Number *
Desired Salary
E-mail address

If under 18, can you produce the necessary work certificate at the time of employment?	Yes	No
Type of employment desired?	Full-Time	Part-time	(Specify hours)
Are you willing to work overtime?	Yes	No	Date on which you can start
Check your available work shifts:	Days	Evenings	Overnight	Weekends
Have you ever applied to this company before?	Yes	No

If Yes, when did you apply?

Where did you apply?

Within the past seven (7) years, have you been convicted of a felony? (Do not include convictions that were sealed, eradicated, erased, or expunged; convictions that resulted in referral to a diversion program; or marijuana-related convictions that are more than two (2) years old.) Yes No

If Yes, please explain so that individual circumstances can be considered.

• Criminal convictions will not automatically disqualify an applicant from a particular job. The Company will consider the nature of the crime, its seriousness, whether the conviction(s) substantially relates to the position’s functions and qualifications, the frequency of convictions, the applicant’s age at the time of conviction, the time elapsed since the date of conviction or completion of jail sentence, the applicant’s entire work and educational history, and employment references and recommendations.
• An ex-offender who is denied employment, may, upon written request, receive a statement of the reason(s) for denial within thirty (30) days of the applicants request for such information .

Have you ever initiated an act of violence in the workplace? Yes No

If Yes, please explain so that individual circumstances can be considered. (A “Yes” will not necessarily disqualify you for employment.)

List special technical skills that you feel qualify you for the job for which you are applying (i.e. computer programming/language, software, equipment operation, special tools or machines, etc.):

HIGHEST LEVEL OF EDUCATION COMPLETED	SCHOOL NAME AND LOCATION	COURSE OF STUDY	GRADUATE?	# OF YEARS COMPLETED	DEGREE/MAJOR
Please provide the highest level of education completed

REFERENCES

Please list the names of additional work-related references we may call. Individuals with no prior work experience may list school or volunteer related references.

NAME	POSITION	COMPANY	WORK RELATIONSHIP	TELEPHONE #

WORK EXPERIENCE

Start with your present or last place of employment. You may include any verifiable work performed on a volunteer basis, internships, or military service.

Employer Name		Address
Phone		Dates Employed From		To
Job Title
Employer Name		Address
Phone		Dates Employed From		To
Job Title
Employer Name		Address
Phone		Dates Employed From		To
Job Title

Industry Experience

Do you have reliable transportation?
How far are you willing to travel for this job?
Lifting capabilities
Industry experience
Construction-level of experience
General labor-level of experience
Hospitality-level of experience
Transportation/auto-level of experience
Events and venues-level of experience
Manufacturing, production, and logistics-level of experience
Food service and packaging-level of experience
Moving services-level of experience
Retail/install/reset-level of experience
Warehouse and distribution-level of experience
Waste and recycling-level of experience
Marine-level of experience
Skilled trade-level of experience
If required, are you willing to submit to a background check?
If required, are you willing to submit to a drug test?

APPLICANT CERTIFICATION

I understand that the Company may now have, or may establish, a drug-free workplace or drug and/or alcohol testing program consistent with applicable federal, state and local law. If the Company has such a program and I am offered a conditional offer of employment, I understand that if a pre-employment (post-offer) drug and/or alcohol test is positive, the employment offer may be withdrawn. I agree to work under the conditions requiring a drug-free workplace, consistent with applicable federal, state and local law. I also understand that all employees of the location, pursuant to the Company’s policy and federal, state, and local law, may be subject to urinalysis and/or blood screening or other medically recognized tests designed to detect the presence of alcohol or controlled drugs. If employed, I understand that the taking of alcohol and/or drug tests is a condition of continual employment and I agree to undergo alcohol and drug testing consistent with the Company’s policies and applicable federal, state and local law.

If employed by the Company, I understand and agree that the Company, to the extent permitted by federal, state, and local law, may exercise its right, without prior warning or notice, to conduct investigations of property (including, but not limited to, files, lockers, desks, vehicles, and computers) and, in certain circumstances, my personal property.

I understand and agree that as a condition of employment and to the extent permitted by federal, state, and local law, I may be required to sign a confidentiality, non-compete, and/or conflict of interest statement.

I certify that all the information on this application, my resume, or any supporting documents is complete and accurate to the best of my knowledge. I understand that any falsification, misrepresentation, or omission of any information may result in disqualification from consideration for employment or, if employed, disciplinary action, up to and including immediate dismissal.

I understand that neither this application nor any communication by a management representative is intended to create or does create a contract of employment, offer, or promise of employment. I acknowledge that if hired by the company, employment is on an at-will basis. This means the company is free to terminate my employment at any time, with our without cause or advance notice, in accordance with state law, and acceptance of employment is not a contract of employment for any specified time. Similarly, I am free to terminate my employment with the company at any time for any reason. This at-will provision may be modified or waived only in a written agreement signed by an authorized representative of the company and me. I agree to conform to the rules and regulations of the company, and I understand that the company has complete discretion to modify such rules and regulations at any time, except that it will not modify its policy of employment at-will.

I authorize the Company or its agents to confirm all statements contained in this application and/or resume as it relates to the position I am seeking and to the extent permitted by federal, state, or local law. I agree to complete any requisite authorization forms for the background investigation.

I authorize and consent to, without reservation, any party or agency contacted by this employer to furnish the above-mentioned information. I hereby release, discharge and hold harmless, to the extent permitted by federal, state, and local law, any party delivering information to the Company or its duly authorized representative pursuant to this authorization from any liability, claims, charges, or causes of action which I may have as a result of the delivery or disclosure of the above requested information. I hereby release from liability the Company and its representative for seeking such information and all other persons, corporations, or organizations furnishing such information.

If hired by this Company, I understand that I will be required to provide genuine documentation establishing my identity and eligibility to be legally employed in the United States. I also understand this Company employs only individuals who are legally eligible to work in the United States. I consent to receiving text messages from this Company.

Applicant Signature

Date