DATE :
NAME : 
ADDRESS:
CITY : 
STATE : 
ZIPCODE : 
REFERRED BY :
PHONE :
EMAIL : 

POSITION DESIRED :
START DATE :
WAGE DESIRED :
ARE YOU CURRENTLY EMPLOYED?
IF YES, PRESENT EMPLOYER:
MAY WE CONTACT YOUR CURRENT EMPLOYER?

EDUCATION:
HIGH SCHOOL:
      GRADUATE?
COLLEGE:
     GRADUATE?
TRADE SCHOOL:
     GRADUATE?
ACTIVITIES: (SPORTS, HOBBIES, CIVIC, ETC.)
FOREIGN LANGUAGES:
READ?
WRITE?
SPEAK?
FORMER EMPLOYMENT ( START WITH LAST JOB FIRST )
LIST DATE, NAME, POSITION, WAGE, AND REASON FOR LEAVING:
PLEASE PROVIDE EMPLOYMENT REFERENCES: (NAME, RELATIONSHIP, YEARS KNOWN, PHONE #)
CA. DRIVERS LICENSE #
Have your ever been convicted of a criminal offense (serious misdemeanor or felony)? (Convictions for marijuana-related offenses that are more than two years old need not be listed.) If yes, state nature of the offense, where and when convicted and disposition of the case.

Consideration for employment will be predicated on successful completion of our pre-employment screening process including background and drug screening.
     CONVICTED?
     IF SO EXPLAIN:
Are you able to perform the essential functions of the job for which you are applying, either with or without reasonable accommodation. If no, describe the function that cannot be performed.
(Note: We comply with the ADA and consider reasonable accommodation measures that may be necessary for eligible applicants/employees to perform essential functions. Hire may be subject to passing a medical examination.)
     IF SO EXPLAIN:
IN CASE OF EMERGENCY NOTIFY (NAME):
ADDRESS:
PHONE #:

By signing below, I authorize investigation of my references, work history, education, driver's license screening, and other matters related to my suitability for employment and, further, authorize the references I have listed to disclose to the company any and all letters, reports and other information related to my work records, without giving me prior notice of such disclosure. I understand that misrepresentation or omission of facts is cause for dismissal. Further, I acknowledge that nothing contained in the application, or if hire, is intended to create an employment contract between me and the Company and that should I be employed, employment is at-will and can be terminated at any time with or without notice.
 

INITIALS:      DATE: