Employment Application Employment ApplicationWe are an Equal Opportunity Employer and fully subscribe to the principles of Equal Employment Opportunity. Applicants and/or employees are considered for hire, promotion and job status, without regard to race, color, religion, creed, sex, marital status, national origin, age, physical or mental disability.0Last Name*1First Name*2Middle Name*3Street Address*4City*5State*6Zip*7Telephone*8Email*91. General Information10Are you able to perform the essential job functions of the position for which you are applying with or without reasonable accommodation?*YesNo11Have you been convicted of any felonies other than minor traffic violations during the past 7 years? (A criminal record or a conviction will not automatically bar employment, but will be considered only as it reasonably relates to your fitness to perform in the position for which you are applying)*YesNo12If yes please explain:*132. Education & Training14Last Grade Completed*select your country123456789101112College 1College 2College 3College 4 MastersDoctorate15Group16High School Name*last attended17Street*18City*19State*20Zip*21Major Course Studied*22Graduated or Degree*YesNo23Average Grade*24Group25College or University Name*26Street*27City*28State*29Zip*30Major Course Studied*31Graduated or Degree*YesNo32Average Grade*33Group34Other School Name*(College, Technical, Vocational, Graduate, etc...)35Street*36City*37State*38Zip*full name39Major Course Studied*40Graduated or Degree*YesNo41Average Grade*42Group43List any scholarships, academic honors, awards or special achievements:*443. Skills45Please list any skills that are appropriate for the position you are applying for:*46If required, will you work?*Rotating ShiftsOvertimeSaturdaysSundays47Position Applying for*be specific48Salary Requirements*49Date you can start*50State fully why you believe you are qualigied for this position:*51INTERESTS / ACCOMPLISHMENTS*You may wishto list significant experience & accomplishments gained while working as a volunteer or as a hobbyist that may be useful in the position (s) you are seeking. Names or organizations designating religion, race, etc. need not be mentioned.524. Employment History53Starting with your PRESENT or MOST RECENT EMPLOYER list in consecutive order ALL EMPLOYMENT for at least the past FOUR employers.54If currently employed, may we contact your employer?*YesNo55Present or most recent employer56Full Name of Company*57(Area Code) Telephone*58Street*59City*60State*61Zip*62Name & Title of Supervisor*63Title of your Position*64List jobs held, duties performed, skills used & promotions while employed at this company*65Salary*Begin and End66Employed From*67Employed To*68Reason for leaving*69Group70Full Name of Company*71(Area Code) Telephone*72Street*73City*74State*75Zip*76Title of your Position*77Name & Title of Supervisor*78List jobs held, duties performed, skills used & promotions while employed at this company*79Salary*Begin and End80Employed From*81Employed To*82Reason for leaving*83Group84Full Name of Company*85(Area Code) Telephone*86Street*87City*88State*89Zip*90Name & Title of Supervisor*91Title of your Position*92List jobs held, duties performed, skills used & promotions while employed at this company*93Salary*Begin and End94Employed From*95Employed To*96Reason for leaving*97Group98Full Name of Company*99(Area Code) Telephone*100Street*101City*102State*103Zip*104Name & Title of Supervisor*105Title of your Position*106List jobs held, duties performed, skills used & promotions while employed at this company*107Salary*Begin and End108Employed From*109Employed To*110Reason for leaving*111Group112READ CAREFULLY:By clicking the "Authorize Button" below, I certify that the information contained in this application is correct to the best of my knowledge and understand that any misstatement or omission of information may result in denial of employment or discharge. I authorize the references listed above to give you any and all information concerning my previous employment and any pertinent information they may have, personal or otherwise, and release all parties from all liability for any damage that may result from furnishing same to you113Authorize114.