WE CONSIDER APPLICANTS FOR ALL POSITIONS WITHOUT REGARD TO RACE, COLOR, RELIGION, CREED, GENDER, NATIONAL ORIGIN, AGE, DISABILITY, MARITAL OR VETERAN STATUS, SEXUAL ORIENTATION, OR ANY OTHER LEGALLY PROTECTED STATUS.
POSITION(S) APPLIED FOR:
WHERE DID YOU HEAR ABOUT US? (PLEASE CHECK ONE)
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FRIEND
WALK-IN
EMPLOYMENT AGENCY
RELATIVE
OTHER(PLEASE SPECIFY)
LAST NAME
STREET ADDRESS
HOME PHONE NUMBER
FIRST NAME
CITY
STATE
CELL PHONE NUMBER
MIDDLE NAME
ZIP CODE
SOCIAL SECURITY NUMBER
IF YOU ARE UNDER 18 YEARS OF AGE, CAN YOU PROVIDE REQUIRED PROOF OF YOUR ELIGIBILITY TO WORK?
NO
YES
HAVE YOU EVER FILED AN APPLICATION WITH US BEFORE?
NO
YES
IF YES, GIVE DATE
HAVE YOU EVER BEEN EMPLOYED WITH US BEFORE?
NO
YES
IF YES, GIVE DATE
ARE YOU CURRENTLY EMPLOYED?
NO
YES
can we contact your present employer?
NO
YES
are you prevented from lawfully becoming employed in this country because of visa or immigration status?
proof of citizenship or immigration status will be required upon employment.
NO
YES
what date would you be available for work?
are you available to work(please select one)
TEMPORARY
SHIFT WORK
PART TIME
FULL TIME
are you currently on “lay-off” status and subject to recall?
NO
YES
can you travel if a job requires it?
NO
YES
have you been convicted of a felony within the last 7 years?
conviction will not necessarily disqualify an applicant from employment
NO
YES
IF YES, please explain
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