Application For Employment

Basic Info

Name		Date
Address
City
State
Zip Code
Telephone Number
Cell Phone Number
Email Address
Position(s) Applied For
Date Available for work
Rate of pay expected- Hourly:		OR Salary:

Location Applying for
Burlington, Wisconsin
Yorkville, Wisconsin
Owensboro, Kentucky
Huntington, Indiana

Are you available for work:

Yes No Full-Time, Please indicate 1, 2, 3, or All shift(s)

Yes No Part-Time, Please indicate time available

Yes No Temporary, Please indicate dates available: Start - End

1. Are you currently employed? Yes No May we contact your present Employer? Yes No

2. Have you ever been employed with us before? Yes No If yes, give date. Start - End -

3. Are you able to perform the essential functions of the job with or without reasonable accommodation?
Yes No If no, state reason.

4. Do you have any responsibilites that confict with the job attendance?
Yes No If yes, state reason.

5. Are you able to work weekends and overtime?
Yes No If no, state reason.

6. Have you ever been convited of a criminal offense (felony or misdemeanor) that has bot ben expunged by a court of law, other than a minor traffic violation? Yes No
If yes, please explain.

Employment History

1.

2.

3.

List Machinery/equipment you have operated

Special training/school received that relates to the job for which you are applying


List Professional/Personal references (name & phone):



How did you hear about us:

	Previously Worked For Us
Job Posting on Recruiting Site:	(List Source)
Company Website ‘ Flier Posted	(Location)
Employee Referral	(Employee's Name)
Other

Applicant's Statment
I certify that answers given herein are true and complete to the best of my knowledge.

I authorize investigation of all statements contained in this application for employment as may be necessary in arriving at an employment decision.

This application for employment will be considered active for a period of time not to exceed 60 days.

I hereby understand and acknowledge that, unless otherwise defined by applicable law, any employment relationship with this organization is of an “at will” nature, which means that the Employee may resign at any time for any reason and the Employer may discharge Employee at any time with or without cause.
It is further understood that this “at will” employment relationship may not be changed by any written document or by conduct unless such change is specifically acknowledged in writing by an authorized executive of this organization.

In the event of employment, I understand that false or misleading information given in my application or interview(s) may result in discharge.I understand, also, that I am required to abide by all policies and expectations of the employer