Employment Application
Hot Openings: SE Days 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? *
If NO - Do you have a green card?
If NO - Do you have a valid work permit & Expirations date?
What foreign languages, if any, do you speak fluently? *
Have you been convicted of a Felony or Misdemeanor within the last 15 years? *
Do you have a valid driver's license? *
Position Applied For? *
Shifts Available? *
Prefer FT or PT?
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?
Are you employed now? *
Current Employer Name *
Current Employer Address *
Employer Phone Number *
Start Date *
End Date *
Wage Rate *
Benefits Received *
Position Held *
Reason for leaving *
Previous Employer Name *
Employer Address *
Employer Phone Number
Start Date *
End Date *
Wage Rate *
Benefits Received *
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
Reference
Name And Address
Telephone #
Previous
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)


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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."