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JOB APPLICATION

Name

EMPLOYMENT APPLICATION

DRUG-FREE WORKPLACE

All employees are subject to drug and alcohol testing procedures permitted under federal and state law.

PERSONAL DATA

Title

First Name *

Last Name *

Email Address *

Street Address *

City, State, and Zip Code *

ADDITIONAL DATA

Social Security Number

*DO NOT ENTER - LEAVE BLANK FOR THIS EXERCISE*

Contact Number *

Alternate Contact Number

How were you referred to us?

Have you ever applied with this company

Are you age 18 or older?

*Note If, NO you may be require to furnish proof of exemption or partial waiver as detailed by State Child Labor Law

Have you ever been terminated or forced to resign from employment?

If so, please explain the circumstances surrounding your termination.

Type of position your are applying for?

Full time

Part time

Temporary

Seasonal

Shift:

Days

Evenings

Nights

Salary / Wage Desired:

Have you previously been employed by our company?

Do you have legal right to work in the United States?

*Note you will be required to provide documentation for completing an I-9 at the time of employment.

Please list any relatives or friends who are employed at this work site and their relationship to you

Date available to start work: *

Will you will overtime if asked? *

Will you will to work weekends if asked? *

Will you will overtime if asked?

Sunday

Monday

Tuesday

Wednesday

Thursday

Friday

Saturday

If selected for employment are you willing to submit to a pre-employment drug screening test? *

Have you ever been convicted of. pled no contest, or found guilty of a felony/misdemeanor?

EDUCATION SKILLS

High School Name, Street, City, Zip

College Name, Street, City, Zip

Graduate School Name, Street, City, Zip

Trade, Business or Vocational School Name, Street, City, Zip

Number of years attended (High School)

Number of years attended (College)

Number of years attended (Graduate School)

Number of years attended (Trade, Business, Or Vocational School)

Did you graduate? Diploma?

Did you graduate? type of Graduate Degree obtained?

Did you graduate? Bachelor Degree obtained?

Did you obtained a degree or certification?

EMPLOYMENT

Employer

Work Address:

Dates employed

Work Street, City, and Zip Code

Work Phone

Postion

May we contact them?

Yes

Pay Rate

Duties performed

ACKNOWLEDGMENT AND AUTHORIZARION

I certify that I have answered all questioned true and complete to the best on my knowledge.

I authorize the investigation of all statements contained in this application for employment as may be necessary in arriving at an employment decision. In the event of employment, I understand that false or misleading information given in my application or interview(s) may result in discharge. *

Application Signature *

Type in your full name indicating your signature of application

Date of Application Submission *

Information Summary

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Email Address

Hours & Info

PO BOX 16741
RAYTOWN, MO 64133

(816) 873-1968

[email protected]

Appointment generally scheduled
Monday - Friday 1 PM to 8 PM
Weekend Hours Vary