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Application for Employment
Our policy is to provide equal employment opportunity to all qualified persons without regard to race, creed, color, religious belief, sex, age, national origin, ancestry, physical or mental disability, or veteran status.
Name (Last, First Middle):
Street Address:
City:
State:
Zip:
Telephone:
Email:
Are you a U.S. citizen or otherwise authorized to work in the U.S. on an unrestricted basis? (You may be required to provide documentation)
Yes
No
Are you looking for full-time employment?
Yes
No
If no, what hours are you available?
Are you willing to work a variety of shifts?
Yes
No
Are you willing to work awake overnight shifts?
Yes
No
Have you ever been convicted of a felony? (This will not necessarily affect your application)
Yes
No
If yes, please describe conditions.
Employment Desired
Position applied for
How did you hear of this opening? (Employee Referral, Employment Ad, Internet Search, etc)
Have you ever applied for employment here?
Yes
No
When?
Where?
Have you ever been employed by this company?
Yes
No
When?
Where?
Are you presently employed?
Yes
No
May we contact your present employer?
Yes
No
Are you available for full-time work?
Yes
No
Are you available for part-time work?
Yes
No
Are you willing to work at multiple locations, that may involve moderate travel?
Yes
No
If yes, what percent?
Date you can start
Desired position
Desired starting salary
Please list applicable skills
Education
High School
Name
Year
Major
Degree
College
Name
Year
Major
Degree
College
Name
Year
Major
Degree
Post-College
Name
Year
Major
Degree
Other Training
Name
Year
Major
Degree
In addition to your work history, are there are other skills, qualifications, or experience that we should consider?
Please list any scholastic honors received and offices held in school.
Are you planning to continue your studies?
Yes
No
If yes, where and what courses of study?
Employment History
(Start with most recent employer)
Company Name
Address
Telephone
Date Started
Date Ended
Starting Wage
Ending Wage
Starting Position
Ending Position
Name of Supervisor
May we contact?
Yes
No
Responsibilities
Reason for leaving
Company Name
Address
Telephone
Date Started
Date Ended
Starting Wage
Ending Wage
Starting Position
Ending Position
Name of Supervisor?
May we contact?
Yes
No
Responsibilities
Reason for leaving
Company Name
Address
Telephone
Date Started
Date Ended
Starting Wage
Ending Wage
Starting Position
Ending Position
Name of Supervisor
May we contact?
Yes
No
Responsibilities
Reason for leaving
References
List three professional references, who have known you for more than one year.
Name
Years Known
Phone
Address
Name
Years Known
Phone
Address
Name
Years Known
Phone
Address
Emergency Contact
In case of emergency, please notify:
Name
Phone
Address
Name
Phone
Address
Please Read Before Submitting
I certify that all information provided by me on this application is true and complete to the best of my knowledge and that I have withheld nothing that, if disclosed, would alter the integrity of this application. I authorize my previous employers, schools, or persons listed as references to give any information regarding employment or educational record. I agree that this company and my previous employers will not be held liable in any respect if a job offer is not extended, or is withdrawn, or employment is terminated because of false statements, omissions, or answers made by myself on this application. In the event of any employment with this company, I will comply with all rules and regulations as set by the company in any communication distributed to the employees. In compliance with the Immigration Reform and Control Act of 1986, I understand that I am required to provide approved documentation to the company that verifies my right to work in the United States on the first day of employment. I have received from the company a list of the approved documents that are required. I understand that employment at this company is “at will,” which means that either I or this company can terminate the employment relationship at any time, with or without prior notice, and for any reason not prohibited by statute. All employment is continued on that basis. I hereby acknowledge that I have read and understand the above statements.
I agree to the above, and certify that all information provided in this application is complete and accurate.
Yes
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Wedgewood -Woodbury, MN
Crest View - Hudson, WI
Belmont - Woodbury, MN
