Application for Employment

EQUAL OPPORTUNITY EMPLOYER. It is our policy to abide by all Federal and State laws prohibiting employment discrimination on the basis of a person's race, color, creed, national origin, religion, age (over 40), sex, marital status, or physical handicap, except where a reasonable, bona fide occupational qualification exists.
All questions must be answered carefully and completely.

PERSONAL DATA
First Name:  Last Name:  MI: 
Social Security No.: 
Address:  Phone Number: 
City:  State:   Zip:  Message Phone: 
Position Desired:  Salary Desired: 
How did you hear about this position opening?  Newspaper A friend or Spice Hunter Employee
Our Web Site Another employment Web Site School Other
Check type of employment desired: Full Time Part Time Temporary
If not Full Time, days available: Mon Tue Wed Thur Fri Sat Sun
If not Full Time, hours available: 
On what date would you be available to start work? 
Have you ever been employed with us before?  Yes No  If yes, give date  
Do you have any friends or relatives working for the Company? Yes No
If yes, state name(s) and relationship: 
Are you currently employed? Yes No  If yes, may we contact your employer? Yes No
If you are applying for a position that will require you to drive while on the job:
Driver's License No:  State of Issue: 
Can you travel if the job requires it?  Yes No
If hired, would you have a reliable means of transportation to and from work?  Yes No
Are you willing and able to work overtime?  Yes No
If hired, can you present evidence of your U.S. citizenship or proof of your legal right to live and work in this country?
Yes No
If you are under 18, and it is required, can you furnish a work permit?
Yes No
Are you able to perform the essential functions of the job for which you are applying, either with or without reasonable accommodation?
Yes No
Have you ever been convicted of a criminal offense (felony or misdemeanor)?
Yes No
If yes, please include explanation. A conviction will not necessarily disqualify you for employment. (Convictions for marijuana-related offenses that are more than two years old , or offenses that led to a referral under a sentencing diversion program, need not be listed.)
Have you ever served in the U.S. Armed Forces? Yes No
If yes, state the branch and # of years of service: 
Were you dishonorably discharged? Yes No
If yes, please attach an explanation. A dishonorable discharge will not necessarily disqualify you for employment.

PROFESSIONAL REFERENCES

Check here if you have no references to list.
List below three people you have worked with for at least one year (do not list supervisors). Do not list relatives or friends unless you have worked with them.
Name: 
Address: 
Occupation:   Company where you worked together: 
Phone No:   No. years acquainted: 
 
Name: 
Address: 
Occupation:   Company where you worked together: 
Phone No:   No. years acquainted: 
 
Name: 
Address: 
Occupation:   Company where you worked together: 
Phone No:   No. years acquainted: 

EMPLOYMENT EXPERIENCE

Check here if you have no previous employment.
Start with your most recent job. Include any job-related military service assignments and volunteer activities. All fields must be filled in, enter "NA" where your employment history is less than four jobs.
Employer:   Dates Employed: From:  To: 
Address:   Hourly Rate/Salary: Starting:  Final: 
Phone Number:  Work Performed: 
Job Title:   Supervisor: 
Reason for Leaving: 
 
Employer:   Dates Employed: From:  To: 
Address:   Hourly Rate/Salary: Starting:  Final: 
Phone Number:  Work Performed: 
Job Title:   Supervisor: 
Reason for Leaving: 
 
Employer:   Dates Employed: From:  To: 
Address:   Hourly Rate/Salary: Starting:  Final: 
Phone Number:  Work Performed: 
Job Title:   Supervisor: 
Reason for Leaving: 
 
Employer:   Dates Employed: From:  To: 
Address:   Hourly Rate/Salary: Starting:  Final: 
Phone Number:  Work Performed: 
Job Title:   Supervisor: 
Reason for Leaving: 

SPECIAL SKILLS AND QUALIFICATIONS

Summarize special job-related skills and qualifications acquired from employment or other experience.
Office Equipment:
Computer Software:
Factory Equipment (i.e. forklift):
Other:

EDUCATION AND TRAINING
High School or Trade School: 
Diploma?  Yes No    Field of study: 
 
Business or Technical School:   Dates Attended: From:  To: 
Name and Date of Degree Earned 
Field of study: 
 
College:   Dates Attended: From:  To: 
Name and Date of Degree Earned 
Field of study: 
 
College:   Dates Attended: From:  To: 
Name and Date of Degree Earned 
Field of study: 
 
College:   Dates Attended: From:  To: 
Name and Date of Degree Earned 
Field of study: 
 
Other Training (Explain):   Dates Attended: From:  To: 
Name and Date of Degree Earned 
Field of study: 

APPLICANT'S CERTIFICATION AND AUTHORIZATION

Please read carefully. Click on the accept button for each paragraph and sign below.

According to the provisions of the California Investigative Consumer Reporting Agencies Act (Civil Code 1786.16) we are providing notification that an Investigative Consumer Report on you may be requested as part of the applicant selection process.

Check here if you would like a copy of the report.
Check here if you waive your right to a copy of the report.
Accept  Decline I hereby certify I have not knowingly withheld any information which might adversely affect my chances of employment and the answers given by me are true and correct to the best of my knowledge. I further certify I, the undersigned applicant, have personally completed this application. I understand any omission or misstatement of material fact on this application or any documents used to secure employment shall be grounds for rejection of this application or for immediate discharge if I am employed, regardless of the time elapsed before discovery.
 
Accept  Decline I hereby authorize any present employer or supervisor, past employer or supervisor, college, university or other institution of learning, administrator, law enforcement agency, state agency, federal agency, finance bureau/office, credit bureau, collection agency, private business, military branch or the National Personnel Records Center, personal reference, and/or other persons, to give records or information they may have concerning my employment records, earnings history, credit history, educational records, character, general reputation, criminal history, motor vehicle history, or other information requested to the Company or its representative. I voluntarily and knowingly unconditionally release any named or unnamed informant from any and all liability resulting from the furnishing of this information. A photographic or faxed copy of the authorization shall be as valid as the original.
 
Accept  Decline I hereby understand and acknowledge any employment relationship with this organization. is of an "at will" nature, which means the Employee may resign at any time and the Employer may discharge the Employee at any time with or without cause. It is further understood this "at will" employment relationship may not be changed by written documentation or by conduct unless such change is specifically acknowledged in writing by an authorized executive of this organization. I further understand this is an application for employment and no employment contract is being offered.
 
Accept  Decline I hereby understand and acknowledge that this is a drug free workplace, and that I must successfully pass pre-employment drug and alcohol testing as a condition of any job offer. I further understand that I may be subject to random drug and alcohol testing during the course of my employment.

I HAVE READ AND UNDERSTOOD THE ABOVE.  
Applicant's Full Name Printed

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