Apply for Part-Time

Position(s) Applied For*

Date of Application*

How Did You Learn About Us?*

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Relative
Employment Agency
Friend
Inquiry
Other

Name*

First Middle Last

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Telephone Number*

Social Security Number

Best time to contact you at home is:*

: HH

MM

If you are under 18 years of age, can you provide required proof of your eligibility to work?

Yes
No

Have you ever filed an application with us before?*

Yes
No

If Yes, give date

Have you ever been employed with us before?*

Yes
No

If Yes, give date

Do any of your friends or relatives, other than spouse, work here?*

Yes
No

Are you currently employed?*

Yes
No

May we contact your present employer?

Yes
No

Are you prevented from lawfully becoming employed in this country because of Visa or Immigration Status?*

Yes
No

Proof of citizenship or immigration status will be required upon employment

Date available for work

What is your desired salary range?

Are you available to work:*

Full-Time (please indicate 1, 2, 3 shift below)
Part-Time (please indicate Mornings, Afternoon, Evenings below)
Temporary (please indicate dates available below)

*

Are you currently on "lay-off" status and subject to recall?*

Yes
No

Can you travel if a job requires it?*

Yes
No

Highest level of education*

Degree/ Diploma Acquired

i.e. A GED / Bachelor's of Finance / Master's of Finance

Describe any specialized training, apprenticeship, skills, and extra-curricular activities*

Describe any job-related training received in the United States military

Present/ Last Employer

Address

Street Address City State / Province / Region

Telephone Number

Job Title

Supervisor

Reason for Leaving

Dates Employed From:

To:

Hourly Rate/Salary Starting:

Final:

Work Performed

2nd Employer

If you were with your most recent employer for more than 5 years, a second employer is not required

Address

Street Address City State / Province / Region

Telephone Number

Job Title

Supervisor

Reason for Leaving

Dates Employed From:

To:

Hourly Rate/Salary Starting:

Final:

Work Performed

List professional, trade, business or civic activities and offices held*

You may exclude membership which would reveal gender, race, religion, national origin, age, ancestry, disability, or other protected status

Other Qualifications*

Summarize special job-related skills and qualifications acquired from employment or other experience.

Specialized Skills (Check skills/Equipment operated)*

Terminal
PC/Mac
Typewriter
Spreadsheet
Word Processing
Shorthand

Production/Mobile Machinery (list)

Other (list)

State any additional information you feel may be helpful to us in considering your application*

Can you perform the essential functions of the job, for which you are applying, either with or without a reasonable accommodation?

Yes
No

Reference

First Last

Phone

Address

Street Address City State / Province / Region ZIP / Postal Code

Reference

First Last

Phone

Address

Street Address City State / Province / Region ZIP / Postal Code

Reference

First Last

Phone

Address

Street Address City State / Province / Region ZIP / Postal Code

Applicant's Statement & Signature*

By typing my full, legal name in the box provided above, I certify that the answers given herein are true and complete. 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 shall be considered active for a period of time not exceed 45 days. Any applicant wishing to be considered for employment beyond this time period should inquire as to whether or not applications are being accepted at that time. 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 and the Employer may discharge Employee at any time with or without cause. 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 rules and regulations of the employer.

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Application For Employment

We consider applications for all positions without regard to race, color, religion, creed, gender, national origin, age, disability, sexual orientation, citizenship status, genetic information or any other legally protected status.

Click here for a downloadable application