When are you available to start work?
Why are you interested in joining our company?
Have you ever been employed by this company before? If Yes, when? If no, enter N/A.
Do you have any friends or relatives employed by this company? If Yes, please provide their names and relationship to you.
Are you currently on "lay off" status and subject to recall?
Yes
No
Are you currently eligible to work in the United States of America?
Yes
No
If you are under 18 years of age, can you provide proof of your eligibility to work?
Yes
No
Will you now or in the future require sponsorship to work within the United States of America?
Yes
No
Are you able to perform all of the essential functions of the job for which you are applying with or without reasonable accommodation? If no, please explain.
If hired, are there any accommodations the company would need to provide in order for you to perform all those essential functions and duties of the position being applied for? If Yes, please explain.
If driving is a requirement of the position applied for, have you in the last 7 years been convicted of Driving Under the Influence "(DUI)"?
Yes
No
If hired, do you have reliable means of transportation to and from work?
Yes
No
If hired, would you be able to travel or work overtime as needed?
Yes
No
INSTRUCTIONS FOR ANSWERING APPLICATION QUESTION ABOUT BEING CONVICTED OF A CRIME OR OTHER STATE-SPECIFIC REQUIREMENTS
A criminal record does not constitute an automatic bar to employment and will be considered only as it substantially relates to the job in question. If you are applying for a position with our company in the following states, please read the following instructions before responding. CA - Do not provide information concerning: (1) any conviction for which the record has been judicially ordered sealed, expunged or statutorily eradicated. or:, (2) any misdemeanor conviction for which probation has been completed or discharged and the case has been judicially dismissed. MA - Have you ever been convicted of a felony? D Yes D No Record If so, when? Within the last five years have you been convicted of or released from incarceration for a misdemeanor, which was not a first offense for drunkenness, simple assault, speeding, a minor traffic violation, an affray or disturbing the peace? 0 Yes 8 No Record (A criminal conviction will not necessarily be a bar to employment. To help us evaluate your application, please describe the nature of the crime and your subsequent rehabilitation.) In Massachusetts, an application for employment with a sealed record on file with the commissioner of probation may answer "No Record" with respect to any inquiry herein relative to prior arrests, criminal court appearances or convictions. An applicant for employment with a sealed record on file with the commissioner of probation may answer "No Record" to an inquiry herein relative to prior arrests or criminal court appearances. In addition, any applicant for employment may answer "No Record" with respect to any inquiry relative to prior arrests, court appearances and adjudications in all cases of delinquency or as a child in need of services which did not result in a complaint transferred to the superior court for criminal prosecution. NV - Only report those convictions that occurred within the past seven (7) years. NB - Only report those convictions that have taken place in the past seven (7) years. Convictions, which have not been annulled, will not necessarily disqualify you from employment. OR - Do not provide information concerning a juvenile record that has been expunged. SD - Have you been convicted of a felony? WA - Limit your answer to convictions for which the date of conviction or prison release, whichever is more recent, is within seven (7) years of today's date.
Have you ever been convicted of a felony or misdemeanor. If yes, please explain.
"I certify that the facts contained in this application are true and complete to the best of my knowledge and understand that, if employed, falsified statements on this application shall be grounds for dismissal, and I agree to hold my employer harmless in the event of my dismissal based thereon.
I authorize investigation of all statements contained herein and to do background checks to give you and all information concerning my previous employment and any pertinent information they may have, confidential or otherwise, and release all parties from all liability for any damage that may result from furnishing same to you.
I realize that under certain legal provisions, pre-employment drug testing could be a condition of my employment. I also acknowledge that the employer may require drug testing at a subsequent time providing that proper advance notice of testing is provided.
I also recognize that I could be offered employment subject to appropriate medical examination and that such a report could nullify my ultimate employment by this employer. I agree to submit to physical examination if required.
I understand and agree that, if hired, my employment is for no definite period and may, regardless of the method of payment of my wages and salary, be terminated at any time without prior notice. If employment is obtained under this application, I will comply with all the rules and policies of my employer."
AN EQUAL EMPLOYMENT OPPORTUNITY EMPLOYER
This employer does not discriminate in hiring or employment on the basis of age, race, color, sex, religion, national origin, disability, military or veteran status
I understand and accept the