Application Date * MM DD YYYY Name * First Name Last Name Address * Address 1 Address 2 City State/Province Zip/Postal Code Country Email * Phone * (###) ### #### Alternate Phone (###) ### #### Position applied for: * Production Full-time Part-time Summer help Please indicate what shift(s) you are ABLE to work * 7am-3pm 3pm-11pm 11pm-7am Rotation 12 hour or non-traditional shifts Are you willing to work overtime? * Yes No Can you work Saturday? * Yes No Can you work Sunday? * Yes No What is your required salary/hourly rate? * When would you be available to begin work? * MM DD YYYY Are you legally eligible to work in the United States * Yes No Are you 18 years or older? * Yes No How did you learn about this job opportunity? * Have you ever been convicted of a crime, excluding misdemeanors? * Yes No If yes, please explain: NOTE: Conviction of a crime is not an automatic disqualification for employment. Have you previously been employed by this company? * Yes No If yes, please explain: EDUCATION Highest Education Level * High School College Trade, Business, or other school N/A Name/Location * Number of years attended Degree Major area of study Employment: list most recent first From: MM DD YYYY To: MM DD YYYY Employer's name and address Wage/Salary Position/Title Supervisor Reason for leaving: Employment 2 From: MM DD YYYY To: MM DD YYYY Employer's name and address Wage/Salary Position/Title Supervisor Reason for leaving: Employment 3 From: MM DD YYYY To: MM DD YYYY Employer's name and address Wage/Salary Position/Title Supervisor Reason for leaving: May we contact your current Employer? * Yes No Have you ever been discharged or asked to resign from a job? * Yes No If yes, please explain: Are you able to perform the essential functions of the position for which you are applying? * Yes No References: do not include relatives or former employers Name Address Phone (###) ### #### Years known Reference 2 Name Address Phone (###) ### #### Years known Reference 3 Name Address Phone (###) ### #### Years known Your submission has been received
