Personal Information First Name Last Name Address City State Zip Phone Email General Employment Position you are applying for Salary Requirements I can legally work in the United States. Yes No I have a CDL B with airbrake. Yes No Are you willing to work Rotating Shifts Yes No Are you willing to work Overtime Yes No Are you willing to work Saturdays Yes No Are you willing to work Sunday Yes No Can you perform the position's job functions with or without reasonable accommodations? Yes No Have you been convicted of any felonies other than minor traffic violations during the past seven years? Yes No (A criminal record or a conviction will not automatically bar employment, but will be considered only as it reasonably relates to your fitness to preform in the position for which you are applying.) If Yes, explain Education Education Completed -Select One- Middle School High School College High School Attended High School Graduated Year High School Average Grade College Attended College Graduated Year College Degree of Study Any Academic Honors or Awards Skills Please list any skills you have that are appropriate for the position you are applying for. State fully why you believe you are qualified for this position. Interests / Accomplishments You may wish to list significant experience, interests, and accomplishments gained while working as a volunteer or as a hobbyist that may be useful in the position you are seeking. Names or organizations designating religion, race, etc. need not be mentioned. Employment History Start with your present or most recent empolyer list, in consecutive order, the past three employers. Current or most recent job. Company Address City State Zip Manager Position Job Duties Employed From/To Date If currently employed, may we contact them? Select One Yes No Reason for Leaving Second or most recent job. Company Address City State Zip Manager Position Job Duties Employed From/To Date Reason for Leaving Third or most recent job. Company Address City State Zip Manager Position Job Duties Employed From/To Date Reason for Leaving 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 the 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 any liability for any damage that may result from furnishing the same to you. We 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, or physical or mental disability.
