Job Application

Date(Required)

Name(Required)

First Last

Primary Phone(Required)

Business / Mobile Phone

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Email(Required)

Personal Information

Position Applying For(Required)

What days are you available to work?(Required)

Monday

Tuesday

Wednesday

Thursday

Friday

Saturday

Sunday

What hours are you available to work?(Required)

If hired, what day can you start working?(Required)

Employment Desired

Do you have any friends or relatives working for the Company?(Required)

Yes

If hired, would you have a reliable means of transportation to and from work?(Required)

Yes

Do you have the legal right to work in the United States?(Required)

Proof of identity and legal authority to work in the United States is a condition of employment.

Yes

Have you ever been convicted of a crime other than a traffic violation?(Required)

Yes

If yes, state the nature of the crime(s), when and where convicted and consequences:

Note: A conviction will not automatically disqualify you for employment. Each case will be individually considered based on specific facts.

Are you currently employed?(Required)

Yes

If so, may we contact your employer?

Yes

Education

High School

No. of Years Completed

Did you Graduate?

Yes

College / University

No. of Years Completed

Did you Graduate?

Yes

Degree/Diploma

Vocational / Business

No. of Years Completed

Did you Graduate?

Yes

Degree/Diploma

Other

No. of Years Completed

Did you Graduate?

Yes

Degree/Diploma

Do you speak, write, or understand any languages in addition to English?(Required)

Yes

If yes, which language(s)?

Do you have any other experience, training, qualifications or skills that especially suit you to work for the Company? If so, please explain

Would you consent to a controlled substance test if one were requested in accordance with Minnesota law (Minn. Stat. §181.951)?(Required)

Yes

Employment History

Please list all present and past employment starting with your most recent employer (last ten [10] years is sufficient). You may omit any information that has been provided in your resume.

Name of Employer 1

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Type of Business

Phone

Your Supervisor's Name

Your Position and Duties

Employment Start Date

Employment End Date

Reason(s) for Leaving

Name of Employer 2

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Type of Business

Phone

Your Supervisor's Name

Your Position and Duties

Employment Start Date

Employment End Date

Reason(s) for Leaving

Name of Employer 3

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Type of Business

Phone

Your Supervisor's Name

Your Position and Duties

Employment Start Date

Employment End Date

Reason(s) for Leaving

REFERENCES

Please list below three persons not related to you who have knowledge of work performance within the last three (3) years:

Name

Relationship

Occupation

Phone

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Number of Years Acquainted

Name

Relationship

Occupation

Phone

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Number of Years Acquainted

Name

Relationship

Occupation

Phone

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Number of Years Acquainted

ACKNOWLEDGEMENTS

Please read carefully and initial each paragraph

I certify that the information contained in this application is true and correct to the best of my knowledge.(Required)

I certify that I, the undersigned applicant, personally completed this application.(Required)

I understand and agree that any misrepresentation, falsification or omission of information on this application or any document used to secure employment shall be grounds for rejection of this application or immediate discharge if I am employed, regardless of the time elapsed before discovery.(Required)

I authorize the Company to thoroughly investigate the information on my application, my references, work record, education and other matters related to my suitability for employment.(Required)

I authorize the references and prior employers I have listed to disclose to the Company all letters, reports, and other information related to my work records, without giving me prior notice of such disclosure. In addition, I hereby release the Company, my former employers, references and all other persons or entities from any and all claims, demands or liabilities arising out of or in any way related to such investigation or disclosures.(Required)

I agree that if, at any time, I make claims against the Company for personal injuries, including but not limited to, workers compensation claims, I will upon request, submit to an examination by a physician of the Company’s choice, at the Company’s expense, as often as may be requested(Required)

The Company adheres to a policy of AT-WILL employment which means that each employee and the Company each retain the right to terminate the employment relationship and that the Company retains the right to modify an employee’s position or compensation at any time, with or without cause or notice. No one other than the President of the Company has the authority to make any binding promise or enter into any agreement inconsistent with Company’s at-will policy, and any such agreement must be in writing and signed by both the employee and the President of the Company to be effective.(Required)

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Job Application

Personal Information

Employment Desired

Education

Employment History

REFERENCES

ACKNOWLEDGEMENTS

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