Employment Application

Personal

First Name *

Please enter your first name

M.I. Middle Initial

Last Name *

Please enter your last name

Please enter a valid email address

Street Address *

Please enter your current address

City *

Please enter your city

State *

Please enter your state

Zip *

Please enter your zip code

Daytime Phone

Evening Phone

Mobile Phone

Please list all names you have used in the past

Have you ever been employed at our Company? *

Yes

If so, date of hire

How were you referred to our Company? *

Employee

Agency

Other

Have you ever applied for employment at our Company? *

Yes

If so, date of previous application

Employment Desired

Position *

Date Available *

Salary Desired ($) *

Per

Are you interested in

Temporary

Full-Time

Part-Time

If part-time, what season(s)?

Summer

Fall

Winter

Spring

Branch location you're applying for?

SoCal

NorCal

Either

Hours available on each day of the week?

Sun

Mon

Tue

Wed

Thu

Fri

Experience

List your last 5 years of work experience, starting with the most recent, including military service. Attach separate sheet if necessary.

May we contact your current employer?

Yes

Employer #1

Employer Name

Address

Telephone

Position

From

Reason for leaving

Employer #2

Employer Name

Address

Telephone

Position

From

Reason for leaving

Employer #3

Employer Name

Address

Telephone

Position

From

Reason for leaving

Employer #4

Employer Name

Address

Telephone

Position

From

Reason for leaving

Employer #5

Employer Name

Address

Telephone

Position

From

Reason for leaving

Education

List education achievements.

College/University

School Name

City, State

Did you graduate?

Yes

Degree earned

Attended

High School

School Name

City, State

Did you graduate?

Yes

Years completed

Skills

Licenses or Certifications

Typing Speed

Word Processing?

Yes

Software

Additional Computer Skills

Other Skills

Can you perform the essential functions of this job, with or without reasonable accommodation? *

Yes

Can you meet the attendance requirements of this job? *

Yes

IF HIRED, I WILL PROVIDE PROOF OF MY LEGAL AUTHORIZATION TO WORK IN THE UNITED STATES *

References

Reference #1

Name *

Company

Title *

Address *

Telephone *

Reference #2

Name *

Company

Title *

Address *

Telephone *

Reference #3

Name *

Company

Title *

Address *

Telephone *

Comments and Resume

Feel free to add additional information that would help clarify any special circumstances.

Upload your resume (optional), limited to PDF files only

Acknowlegements

Please read carefully, initial each paragraph and sign at the bottom of the page.

Please enter your initials

I hereby certify that I have not knowingly withheld any information that might adversely affect my chances for employment and that the answers given by me are true and correct to the best of my knowledge. I further certify that I, the undersigned applicant, have personally completed this application. I understand that any omission or misstatement of material fact on this application or on any document used to secure employment shall be grounds for rejection of this application or for immediate discharge if I am employed, regardless of the time elapsed before discovery. *

Please enter your initials

I hereby authorize the Company to thoroughly investigate my references, work record, education and other matters related to my suitability for employment and, further, I authorize the references I have listed to disclose to the Company all letters, reports and other information related to my work records, without giving me prior notice of such disclosure. In addition, I hereby release the Company, my former employers and other persons, corporations, partnerships and associations from any and all claims, demands or liabilities arising out of or in any way related to such investigation or disclosure. *

Please enter your initials

I understand that nothing contained in the application, or conveyed during any interview which may be granted, or during my employment, if hired, is intended to create an employment contract between the Company and me. In addition, I understand and agree that if I am employed, my employment is at will and is for no definite or determinable period and may be terminated at any time, with our without prior notice, or with or without cause, at the option of either myself or the Company, and that no promises or representations contrary to the foregoing are binding on the Company unless made in writing and signed by me and the Company’s designated representative. *

Please enter your initials

I understand that in connection with my application for employment, the Company may obtain a consumer report and/or investigate consumer reports about me that may contain information as to my character, general reputation, personal characteristics, and mode of living. Such reports may include or consist of my driving history obtained from the Department of Motor Vehicles. I further understand that any job offer extended by the Company is contingent upon receipt of a favorable consumer or investigative consumer report about me. *

Please enter your initials

I understand that in connection with my application for employment, depending upon the position for which I have applied, any offer of employment is conditioned upon my taking and passing a post-offer/pre- employment drug test, and if necessary for the position for which I have applied, a post-offer/pre-employment medical examination. I understand that I may refuse to take any required pre-employment drug test and/or medical examination, but that if I do, any offer of employment will be immediately withdrawn. *

Please enter your initials

I HAVE READ THE ABOVE PARAGRAPHS, UNDERSTAND THEIR IMPORTANCE AND EFFECT UPON MY EMPLOYMENT, AND ACCEPT SAME AS CONDITIONS OF MY EMPLOYMENT WITH COMPANY. *

Sign by entering your name *

Please enter your name to sign this application

Application Date *

Please enter the date you're applying for employment

This application, when completed and signed, becomes the property of Company.

Personal

Employment Desired

Hours available on each day of the week?

Experience

Employer #1

Employer #2

Employer #3

Employer #4

Employer #5

Education

College/University

High School

Skills

References

Reference #1

Reference #2

Reference #3

Comments and Resume

Acknowlegements

Products

Support

More

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