Application for Employment

The Company, an Equal Opportunity Employer, does not discriminate in hiring or terms and conditions of employment because of an individual’s race, religion, color, sex, age, national origin, marital status, or disability. Please answer all the questions as thoroughly as possible. YOUR APPLICATION WILL BE CONSIDERED ACTIVE FOR SIXTY (60) DAYS. FOR CONSIDERATION AFTER THAT YOU MUST REAPPLY. If you are a qualified individual with a disability, you may request any needed accommodation to participate in the application process.

The Company Tests for Drug Use

=========================================

	Personal Information
	Name:
	Address:
	City, State, ZipCode:
	Home Telephone No.:
	Business Telephone No.:
	Are you at least 18yrs. of age or older ?	Yes No
	Can you, after conditional hire, submit proof of your identity and legal right to work in the United States? Yes No
	Position Applied for:
	Date you can begin:
	Salary Desired $:
	Will you work	full-time: part time: temporary:
	Specify the days and hours if part-time:
	Will you work on Saturday ?	Yes No
	Will you work on Sunday ?	Yes No
	Are you available to work over time when necessary ?	Yes No
	Are you able to perform the functions of the job for which you are applying (essential and/or marginal) with or without a reasonable accommodation? Yes No
	Are you currently employed?	Yes No
	May we contact your employer?	Yes No
	Current Salary:$	per hour week yearly
	Have you been convicted of any crime?	Yes No (a conviction will not necessarily disqualify you from employment)
	If Yes, please explain:
	Have you ever been discharged or requested to resign from a position? Yes No
	If Yes, give circumstances:
	Have You attended High School? Yes No Name of school:
	No. of years attended: Did you graduate? Yes No
	Have you attended College? Yes No Name of school:
	No. of Years attended: Did you graduate? Yes No
	Please indicate any additional training:
	Prior Work Experience (most recent first)
	Company:
	Location:
	Phone:
	Dates Worked:	From To
	Duties:
	Salary: $
	Reason for Leaving:
	Company:
	Location:
	Phone:
	Dates Worked:	From To
	Duties:
	Salary: $
	Reason for Leaving:
	Company:
	Location:
	Phone:
	Dates Worked:	From To
	Duties:
	Salary: $
	Reason for Leaving:
	Work Experience References
	Please list references other than relatives: (include there Name, Company, Position, Phone Number, Years Acquainted)
	1:
	2:
	3:
	State any additional information you feel may be helpful to us in considering your application:

Thank you for taking the time to fill out our application. Please press the submit buttonto send the information to us. We will be contacting you soon.