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Employment Application
Hot Opening:  2nd Shift Greater Grand Rapids

* Required fields
Name *
E-mail Address *
Present Street Address *
City
State
Zip
Current Home Telephone *
Current Cell Telephone
Are you a U.S citizen? * Yes
No
If NO - Do you have a green card? yes
no
If NO - Do you have a valid work permit & Expirations date? yes
no
What foreign languages, if any, do you speak fluently? *
Have you been convicted of a Felony or Misdemeanor within the last 15 years? * Yes
No
Do you have a valid driver's license? * Yes
No
Position Applied For? *
Shifts Available? First
Second
Third
First and Second
Second and Third
First and Third
Any
Prefer FT or PT? Full Time
Part Time
Date you can start? *
Do you have any special skills that may be helpful? *
If so, may we inquire of your present employer? *
Name of High School *
Location of School? *
Number of years attended? *
Did you graduate? *
Subjects Studied *
College *
Name and location of School *
Number of years attended? *
Did you graduate? *
Subjects Studied *
Trade, Business or correspondence school *
Name and location of School *
Number of years attended *
Did you graduate? *
Subjects Studied *
Are you active with the U.S. Military or Naval Service? *
Rank *
Are you presently in the National Guard or Reserves? Yes
No
Are you employed now? * Yes
No
Current Employer Name *
Current Employer Address *
Employer Phone Number *
Start Date *
End Date *
Wage Rate *
Benefits Received * Individual Health
Dental
Family Health
none
Position Held *
Reason for leaving *
Previous Employer Name *
Employer Address *
Employer Phone Number
Start Date *
End Date *
Wage Rate *
Benefits Received * Individual Health
Dental
Family Health
None
Position Held *
Reason For Leaving *
Previous Employer Name *
Employer Address *
Employer Phone Number
Start Date *
End Date *
Wage Rate *
Position Held *
Reason for leaving *
Previous Employer Name *
Previous Employer Address *
Employer Phone Number
Start Date *
End Date *
Wage Rate *
Position Held *
Reason for leaving
Reference *
Name And Address *
Telephone # *
Previous * Business
Personal
Reference *
Name And Address *
Telephone # *
Previous * Business
Personal
Reference *
Name and Address *
Telephone # *
Business/personal *
Do you have any physical limitations which would prevent you from performing duties for the position you are applying for? *
If yes, What can be done to accomodate your limitation? (Please Describe)

I have read and agree to the Privacy Policy *

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By submitting this form" I certify that the facts contained in this application are true and complete to the best of my knowledge and understand that, if employed, falsified statements on this application shall be grounds for dismissal. I authorized investigations of all statements contained herein and the references listed above to give you any and all information concerning my previous employment and my pertinent information they may have, personal or otherwise, and release all parties from all liability for any damages that may result from furnishing same to you.  I understand and agree that, if hired, my employment is for no definite period and may, regardless of the date of payment of my wages and salary, be terminated at any time without prior notice."