General Information

Position Applied For:

Full Name:
Address:
City: State: Zip:
Telephone #:

Referral Source:
Newspaper
Unemployment office
Website
Radio
Other

Are you at least 18 years of age?
Yes
No

All postions require having a current driver's license and maintaining a driving record of good standing.
Driver's License #:
State Issued:
Expiration Date:

Are you legally eligible for employment in the U.S.?
(Proof of U.S. Citizenship or immigration status will be required if hired.)
Yes
No

What type of work are you seeking?
Temporary Job
Full Time
Part Time
Summer Work

When are you willing to work when needed?
Overtime
Weekends
Holidays-if necessary

Are you currently employed?
Yes
No

If hired, when are you available to start work:

Salary Expecation (Starting Wage):

Employment History

Start with your most recent employer. Include any job-related military service assignments and volunteer activities. You may exclude organizations, which indicate race, color, religion, gender, national orgin, handicap, or other protected status.

Employer:
Address:
Telephone Number:

Dates of Employment:
From: To:
Last Hourly Rate:
Job Title:
Supervisor's Name:
List Job Duties:
Reason for Leaving:
May we contact this employer for a reference check?
Yes
No

Employer:
Address:
Telephone Number:

Dates of Employment:
From: To:
Last Hourly Rate:
Job Title:
Supervisor's Name:
List Job Duties:
Reason for Leaving:
May we contact this employer for a reference check?
Yes
No

Employer:
Address:
Telephone Number:

Dates of Employment:
From: To:
Last Hourly Rate:
Job Title:
Supervisor's Name:
List Job Duties:
Reason for Leaving:
May we contact this employer for a reference check?
Yes
No

Education

List all High School, College, University, or Technical Training.

School:
Years Completed:
Degree/Certificate:

School:
Years Completed:
Degree/Certificate:

School:
Years Completed:
Degree/Certificate:

Describe any specialized training, apprenticeship, skills, and extra-curricular activities:

References

Please list three references that have known you professionally-do not include family members.

Name:
Telephone Number:

Name:
Telephone Number:

Name:
Telephone Number:

By submitting this form:

I understand and agree that the information that I have provided on this application is true and complete to the best of my knowledge. Any misrepresentation or omission of any facts in my ap plication, resume, or any other materials, or during my interview, can be justification of refusal of employment as may be necessary in arriving at an employment decision.

I understand that as a condition of employment, I may me required to undergo and successfully pass a post employment physical and drug/alcohol test.

I herby understand and acknowledge that, unless otherwise defined by applicable law, any employment relationship with Bolger Brothers, Inc., is of an "at will" nature", which means that the employee may resign at any time with or without cause and the employer may discharge teh employee at any time with or without cause.

I also understand that I am required to abide by all rules and regulations of the employer.