Federal Law and Illinois Stage Law prohibits discrimination in employment because of race, color, religion, sex. handicap, citizenship or national origin.
We are an equal opportunity employer.
*Position(s) applied for:
*Full Name:
*Street:
*City:
*State:
*Zip Code:
*Are you 18 years of age or older? Yes No
*Have you ever been employed here before? Yes No
*Are you legally eligible for employment in this country? Yes No
Type of employment desired: Full-Time Part-Time Temporary
*Have you ever been dismissed or forced to resign from any employment? Yes No
If yes, identify name(s) and relevant dates:
*Have you been convicted of a felony within the last five years? Yes No
YOU ARE NOT OBLIGATED TO DISCLOSE SEALED OR EXPUNGED RECORDS OF CONVICTION OR ARREST. ANSWERING "YES" TO THESE QUESTIONS DOES NOT CONSTITUTE AN AUTOMATIC BAR TO EMPLOYMENT. FACTORS SUCH AS DATE OF THE OFFENSE, SERIOIUSNES AND NATURE OF THE VIOLATION, REHABILITATION AND POSITION APPLIED FOR WILL BE TAKEN INTO ACCOUNT
Employer:
Ending Job Title:
Address:
Supervisor:
Summarize the nature of the work performed:
Reason for Leaving:
Hourly Salary/Wage:
*May we contact your present employer? Yes No
*May we contact your previous employer? Yes No
Please identify any exceptions and reasons for not contacting:
Branch of the U.S. Armed Forces/Nat'l Gaurd/Reserves:
Rank or Rating when entered:
List of special training:
Rank or Rating when discharged:
High School:
Did you graduate? Yes No
College:
Trade School:
Dates Attended:
List any special technical and skilled trade areas that you have experience in:
List any special training, skills, licenses, and/or certifications that may qualify you as being able to preform this job:
I certify that all information I have provided in order to apply for and secure work with the employer is true, complete and correct.
I recognize that any employment offered will be conditional on satisfactory completion of a pre-employment physical examination.
I also a free that I will voluntary submit to a drug screening if the company deems such screening to be necessary. I acknowledge that a positive drug test is a sufficient reason to terminate employment of for a refusal to hire.
I understand that any information provided by me that is found to be false, incomplete or misrepresented in any respect, will be sufficient cause to (i) cancel further consideration of this application or (ii) immediately discharge me from the employer’s service, whenever it is discovered.
I also understand that if I am hired, I will be required to provide proof of identity and legal authority to work in the United States and that federal immigration laws require me to complete an I-9 Form in this regard.
This application des not constitute an agreement of contract for employment for any specified or definite duration. I understand that no supervisor or representative of the employer is authorized to make any assurances to the contrary and that no implied, oral or written agreement contrary to the foregoing express language are valid unless they are in writing and signed be the employer’s president.
Attach your Resume
Do Not Sign Until You Have Read The Above Application Statement.
*I certify that I have read, fully understand and accept all terms of the foregoing Applicant Statement.
*Date:
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