Employment Application Form Your Personal InformationYour Name* First Last Today's Date* Date Format: MM slash DD slash YYYY Your Email Address* Your Home Address* Street Address Unit / Suite Number City State Zip Code Your Phone*Your Alternative Phone*Best Time To Call You*When is the best time for us to reach you via telephone?Best Time To Call YouMorningsEarly AfternoonLate AfternoonEarly EveningAre you over the age of 18?*yesno (employment is subject to verification that you are of minimum legal age)Are you currently eligible to work in the U.S.?*yesno (employment is subject to verification that you are of minimum legal age)Can you provide documentation that you are eligible to work in the U.S.?*yesno (employment is subject to verification that you are of minimum legal age)Employment InformationPosition You Are Applying For*PresserScrub/Nob Assembly AttendantFluff and Fold AttendantFolder AttendantWasher/Dryer AttendantSoil Linen Sorter-CounterPack-Out AttendantLocal Relief DriverRoute RepresentativeDate available to work* Date Format: MM slash DD slash YYYY Desired Shift*FirstSecondThirdDesired type of employment*Full TimePart TimeTemporaryDesired salary or rate of pay*Hours You Are Available for Work*Please tell us what hours you are available for work each day of the week. Please include start time and end time. MondayTuesdayWednesdayThursday *FridaySaturdaySunday General QuestionsCan you perform the essential job functions for which you are applying, with our without reasonable accommodation?*yesnoHave you ever held a position of trust (handling money or confidential material)?*yesnoDo you have reliable transportation to work?*yesnoHave you ever been discharged or asked to resign?*yesnoDo you have any friends or relatives that currently work here?*yesnoHave you ever been bonded?*yesnoHave you ever been refused bond?*yesnoDoes your present employer know of your plans to change employment?*yesnoWhy do you desire to make a change?*Education Information*What is your highest level of education completed?LicensesList any applicable licensesPrevious EmploymentYour Previous Employers*Please list your previous employers, the dates you worked and the position you heldEmployerDatesPositionPhone *Business NumberStarting Rate $Ending Rate $ Date Hired* Date Format: MM slash DD slash YYYY Supervisor (Name & Position)*Job Title and Duties*Reason for Leaving*EmployerDatesPositionPhone *Business NumberStarting Rate $Ending Rate $ Date Hired* Date Format: MM slash DD slash YYYY Supervisor (Name & Position)*Job Title and Duties*Reason for Leaving*EmployerDatesPositionPhone *Business NumberStarting Rate $Ending Rate $ Date Hired* Date Format: MM slash DD slash YYYY Supervisor (Name & Position)*Job Title and Duties*Reason for LeavingMay we contact the employers listed above?*yesnoIf not, indicate which ones(s) you do not wish us to contact.*More About YouTell Us About Yourself*The Legal StuffTerms and ConditionsThe facts set forth above in my application for employment are true and complete. I understand that if employed, false statements or omission of information on this application, a resume, or other applicant information provided may be considered sufficient reason for dismissal. I understand that consumer reports which may contain public record information may be requested from the reporting agency. These reports may include information as to my character, work habits, performance, and experiences along with the reasons for termination of past employment from previous employers. Further, I understand that you may be requesting information from various federal, state, and other agencies which maintain records concerning my past activities relating to my driving, credit, criminal, civil, and other experiences. I understand that I have the right to make a written request within a reasonable period of time to receive additional detailed information about the nature and scope of this investigative consumer report. I authorize the use of any information in this application to verify my statements, and I authorized the past employers, all references, and any other persons to answer all questions asked concerning my ability, character, reputation, and previous employment record. I release all such persons from any liability or damages on account of having furnished such information. I understand that employment at this organization is on an “at will” basis, and includes no guarantee, contract, or promise of employment for any specific length of time. Acceptance* I agree to the Terms and Conditions Enter Initials*Entering your initials here is to be considered an electronic signaturePhoneThis field is for validation purposes and should be left unchanged.