Please fill the information below and a human resource representative will contact you in short notice. All Fields are required if you don't have any information for a field please put N/A. Thank you

305-642-6003


 

PERSONAL INFORMATION

Name First
Street Address Middle
City State
Zip Home Phone
Work Phone Fax
Email Social Security
Driver's License State Expiration

 

EMPLOYMENT DESIRED

Position Applied For :
How did you hear about this position ?
Date available for work:
Desired hours :

 

EDUCATION

  Name and Address of School Course of Study Total Years of Study Degree / Diploma
High School
Undergraduate
Graduate/Professional
Other/Specify
List any seminars, classes or other education not listed above which may help you qualify you for this position
Last Name, First Initial Today's Date

 

EMPLOYMENT HISTORY

List Below all present and past employers over the past ten years, starting with your most recent employer. Account for all periods of unemployment. You must complete this section even if attaching a resume.

1.

Employer (current) Supervisor(s)
Start Date End Date
Address City
State Zip
Phone Fax Number
Starting Salary Ending Salary
Job Position Email Supervisor
Essential Job Functions of Final Position
Reason for Leaving

What Value did you add to this

Company or its customers ?

 

2.

Employer (current) Supervisor(s)
Start Date End Date
Address City
State Zip
Phone Fax Number
Starting Salary Ending Salary
Job Position Email Supervisor
Essential Job Functions of Final Position
Reason for Leaving
What Value did you add to this Company or its customers ?

 

ADDITIONAL INFORMATION

List any Professional, Trade, Business or Civic Activities and offices held. You may exclude membership that would reveal Gender, Race, Religion, National Origin, Ancestry, Age, Disability or any other Protected Status

List any languages other than English that you can speak, read or write that could be of benefit to the position applied for.
  Fluent Good Fair
Speak
Read
Write

Identify Formal Job Training that relates to this Position
Identify what skills or certification you possess related to this position
If you are hired what value would you add to our Company ?
Describe what you believe are the most unique features of your work history ?
Have you ever been employed with this Company before ?
If Yes, When
Do you have any Friends or Relatives employed by this Company ?
If Yes, Please provide their Names and Relationship to you
Are you Currently employed ?
May we contact Your Employer ?
Are you Currently on "Lay Off" Status and subject to recall ?
If you are under 18 Years of Age, Can you provide proof of eligibility to work ?
If Hired, can you provide proof of U.S. Citizenship or Proof of your legal right to work in the U.S. ?
Are you able to Perform all of the essential functions of the job for which you are applying with or Accomodation ?
If No 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)" ?
If hired, do you have a reliable means of transportation to and from work ?
If hired, would you be able to travel or work overtime if needed ?
Have you ever been convicted of a felony or Misdemeanor ?
If Yes, Please explain :

 

REFERENCES

List below three persons NOT related to you who have knowledge of your work performance within the last 5 years.

Name Occupation
Company Name Telephone
Address Email Address
Relationship Years Acquainted

 

Name Occupation
Company Name Telephone
Address Email Address
Relationship Years Acquainted

 

Name Occupation
Company Name Telephone
Address Email Address
Relationship Years Acquainted

 

ADDITIONAL SPACE

Additional Space provided to explain any points or questions asked previously in this form

 

Please Read each statement closely and initinal each acknowledging your understanding

Equal Employment Opportunity Statement

This Company is committed to the principles of equal employment opportunity and is committed to make employement decisions based on merit. We are committed to complying with all Federal, State and local laws providing for equal employment opportunities, as well as all laws related to terms and conditions of employment. The Company desires to maintain a work environment that is free of sexual harassment and discrimination due to race, religion, color national origin, physical or mental disability, age or any other status protected by Federal, State or local laws. The Company will make reasonable efforts to accommodate those physical or mental limitations of an otherwise qualified employee unless undue hardship would result for the company.

Discrimination and Sexual Harassment Policy Statement

This Company will not tolerate any form of unlawful discrimination, including sexual harassment. Any employee who engages in unlawful discrimination or sexual harassment will be subject to appropriate discipline, up to and including termination. Prohibited sexual harassment is defined as follows: Unwelcome sexual advances, Requests for sexual favors and other verbal or physical conduct of a sexaul nature constitute sexual harassment when (1) submission to susch conduct is made whether explicitly or implicitly a term or condition of an idividual's employment; (2) submission to or action of such conduct by an individual is used as the basis for employment decisions affecting such individuals; or (3) such conduct has the purpose or effect of unresasonable interfering with an individual's work perfomance or creating and intimidating, hostile or offensive work environment.

Disclosure to applicants concerning Drug / Alcohol Testing

If you are offered a position with a Company, you may be given a drug/alcohol test as a condition of employmnet. Your refusal to timely submit to a drug/alcohol test or your failure to pass such a test means you will njot be emloyed by this company. Neither the collector of specimens nor the medical professional who reviews the test results will be a company employee. The test results will be kept confidential. The individual undergoing testing will not be directly observed while providing the specimen unless there are reasonable grounds to believe the individual may alter or substitute the specimen. Negative test results ar required as a condition of emloyment.

Complete and Accurate Information

I hereby certify that I have not knowingly withheld any information that might adversely affect my chances for employment and that the answers given by me are true and correct to the best of my knowledge. I further certify that I have personally completed this application. I understand that any omission or misstatement of materai fact on this application or for immediate discharge if I am employed, regardless of the time elapsed before discovery.

At-Will Employment

I understand and agree that if I am employed, my employment will be "at-will", which means that the Company may terminate the employment relationship at any time, with or without cause and with or without notice. Likewise, the Company will respect my right to terminate my employment at anytime, with or without cause and with or without notice. I further understand that any prior representation, whether expressed or implied to the contrary is hereby superseded and that no promise or representation contrary to the foregoing is binding on the Company unless made in within and signed by the Company's president.

Testing Authorization

If offered a position with the Company, I hereby agree to any legally permitted physical, psychological, skill, drug or medical test required by the Company as a condition of employment.

Investigation Authorization

I authorize investigation into all statements and references contained in this application. Said investigation may include credit, driving, criminal background, references and other background checks. By applying for this job, I also authorize post-hire investigation into my credit, driving, and criminal background.

Company Obligation

I understand and agree that the Company's acceptance of this job application does not meant that a position for which I am qualified is open (unless specifically posted) or that the Company has agreed to hire me. I understand that the Company is under no obligation to hire me as the result of accepting this completed application.

 

I have read and Understood the above policy statements and agree to be bound by them if employed by the Company.

Please type your for proof of Signature