Job Application 1 2 3 4 5 6 Name* First Middle Last Social Security No.(If hired, you must have or obtain a Social Security number for payroll purposes.)Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaRéunionSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Residence TelephoneAlternate TelephoneDate of Application Date Format: MM slash DD slash YYYY Date Available Date Format: MM slash DD slash YYYY Expected Pay RangeIMPORTANT: Any applicant providing un-requested information on this application, or on any attachments or supporting documents, will automatically be disqualified from consideration. IMPORTANT: Applicants with disabilities may request any reasonable accommodation necessary to complete this application, or to take any test required for the position for which the applicant has applied, by making a request at the time of application or testing. EQUAL EMPLOYMENT OPPORTUNITY. It is our policy to seek and employ the best qualified personnel, to provide equal opportunity for the advancement of employees and to administer all of our personnel policies in a manner that will not discriminate against any person because of race, color, religion, age, sex, marital or veteran status, national origin, ancestry, disability, on-the-job injuries, sexual orientation, source of income, or any other legally protected status unless it is a bona fide occupational requirement reasonably necessary to the operation of our business. Have you ever worked for us before?*YesNoAre you 18 years of age or older?*YesNoPosition(s) Applied For:*ANY AREA(S) NEEDEDWhen are you available to work?*Check shifts and days you can work: (We will attempt to reasonably accommodate employees who require certain hours or days off because of religious beliefs or practices.) Days Swing Graveyard Rotating Mon Tues Wed Thurs Fri Sat Sun Proof of Citizenship*If you are hired, are you prepared to present evidence within three days of beginning work showing that you are legally authorized to work in the United States?YesNoRELATIVES/FRIENDS*Qualified relatives/friends are eligible for employment except in unusual situations where we need to avoid possible conflicts of interest. Do you have any relatives/ friends (such as roommates) who currently work for us?YesNoIf yes, state name(s): QUALIFICATIONS: Please list any education, training and/or specialized experience (such as schools; colleges; degrees; licenses; vocational, technical or military experience; hobbies, etc.) that you feel would help you perform the work for which you are applying:Degrees / Licenses / Relevant Education / Training*Where did you aquire it?*(Name/address of school, program, military branch and specialty, etc.) CRIMINAL RECORD: Conviction of a crime is not an automatic bar to employment. Factors such as the nature and gravity of the crime, the length of time since the conviction and/or completion of any sentence, and the nature of the job for which you have applied will be considered. Do not list any arrest, charge or detention that did not result in conviction or any arrest, charge, detention or conviction that has been judicially expunged, sealed, impounded or eradicated.DRIVING POSITIONS: (Answer only if driving is an essential function of the job.)Do you have a valid driver's license?*YesNoLicense No.StateTraffic Violations*Have you ever been CONVICTED, pled GUILTY or NO CONTEST, or FORFEITED BOND OR BAIL for any traffic violations, offenses or citations, regardless of how they were classified or whether minor or major, in the past three years?YesNoProvide DetailsIN CASE OF EMERGENCY NOTIFY (name - phone) EMPLOYMENT EXPERIENCE: Please account for all periods of employment by month/year, including any self-employment and U.S. military service.Previous EmployersEmployerHire DateDate LeftStarting PayFinal PaySupervisor NameSupervisor PhoneSupervisor AddressJob Title / Job DutiesReason For Leaving Have you ever been terminated?*Or quit because you believed that you might be terminated or at an employer’s request.YesNoIf yes, please identify employer and explain circumstances. I authorize the investigation of all matters which the Company deems relevant to my qualifications for employment, including all information given in this application and in any attachments, supporting documents or interviews. I authorize you to request and receive such information and I release from all liability any persons (such as current or former supervisors, coworkers, etc.), employers, or other entities (schools, etc.) Supplying it. I also release you from all liability which might result from making the investigation. I certify that all of the information given in this application and in any attachments, supporting documents or interviews is (or will be) true and complete to the best of my knowledge. I understand that any falsification, misrepresentation or omission, as well as any misleading statements or omissions, generally will result in denial of employment, withdrawal of any offer of employment, or immediate termination, regardless of when and how discovered. I understand that I may be required to submit to pre- or post-employment physical or other professional examinations, medical inquiries and/or urinalysis tests for the presence of drugs and/or alcohol. IMPORTANT: This means that with very few exceptions — for example, operations located in states where it may not be lawful — an employee will be required to submit to testing in several different circumstances. Ask to see copies of our applicant and employee alcohol and drug policies if you have any questions. I agree to such examinations, inquiries and/or testing at the Company's expense. I authorize release of the results to the Company and their use to evaluate my suitability for employment. I also release the Company from all liability arising out of or connected with any examinations, inquiries and/or testing. I understand that I may resign or be terminated, without cause or notice, at any time, unless otherwise stated in a written employment contract. I also understand that unless otherwise stated in a written employment contract, the Company may change, withdraw and interpret other policies (including wages, hours and working conditions) as it deems appropriate. This application will only be considered active for two weeks. I understand that if I have not been contacted by the Company within two weeks that if I still want to be considered for employment, I will need to reapply and complete a new employment application. I understand and agree that if I am hired the statements in these paragraphs will become a binding part of my employment relationship. I have read each of these statements. I have also reviewed all of the information provided in this application and in any attachments or supporting documents. Agree to the above:*YesNoPhoneThis field is for validation purposes and should be left unchanged.