Application for Employment
An Equal Opportunity Employer
We do not discriminate on the basis of race, color, religion, national origin, sex, age, disability, or any other status protected by law or regulation. It is our intention that all qualified applicants be given equal opportunity and that selection decisions be based on jobrelated factors.
Answer each question fully and accurately. No action can be taken on this application until you have answered all questions. Use blank paper if you do not have enough room on this application. PLEASE PRINT, except for signature on second page of application.
In reading and answering the following questions, be aware that none of the questions are intended to imply illegal preferences or discrimination based upon non-job-related information.
Job Applied for: Trainee/General Duties
Are you seeking: Full-Time ___

Part-Time___

Today’s Date: ______________
Temporary___

employment?

When could you start work?

_____________________________________________________________________________
Last Name
First Name
Middle Name

_________________
Telephone #

____________________________________________________________________________________________________________
Present Street Address
City
State
Zip Code
Are you 18 years of age or older?............................................................................................... Yes____

No____

Social Security #_________________ If hired, can you furnish proof you are eligible to work in the U.S.? Yes ___ No___

Have you ever been convicted of any law violation? Include any plea of “guilty” or “no contest.” Exclude minor traffic violations………………………………………………………………………………………………………………………………………………………….. Yes____ No____
If yes, give details ______________________________________________________________________________________
Do you have a valid driver’s license?