WILLIAMS CHEESE EMPLOYMENT APPLICATION

* Required Field

PERSONAL DATA

* First Name

Middle Initial

* Last Name

Maiden Name

Date of Birth

Phone

E-mail Address

Street Address

City/State/Zip

How did you find out about this job?

Minimum Salary Expected

Are you at least 18 years old?
Yes
No
Driver’s License Number

State Issued

Expiration Date

Are you legally eligible for employment in the U.S.?
Yes
No
Proof of U.S. citizenship or immigration status will be required if hired.
Have you been convicted of a crime?
Yes
No
State the nature of the offense and disposition of the case. Include dates and places. (NOTE: The existence of a criminal record does not constitute an automatic bar to employment.)




EMPLOYMENT DATA

Status
Full Time | Part Time | Temporary
Which position are you applying for?

Which hours and shift(s) would you prefer to work?

Which hours and shift(s) would you prefer NOT to work?

Would you like to work weekends?
Yes
No
Would you like to work holidays?
Yes
No
Are you currently employed?
Yes
No
If hired, when would you be able to start?

Have you ever worked for Williams Cheese?
Yes
No
What name did you use when you were last employed with Williams Cheese?


List any friends or relatives employed by this company

Are you on layoff and subject to recall?
Yes
No
Have you ever been discharged or asked to resign from any position?
Yes
No
Please explain the reason for discharge or resignation


How many days have you missed from school or work within the last year other than approved vacation, sick, or disability leave?

How many days have you been late from school or work within the last year other than approved vacation, sick, or disability leave?

Are you able to perform all the tasks for the job you are applying for?
Yes
No
Please explain why you can not perform the tasks for the job you are applying for



EDUCATION HISTORY

High School or Equivalent Name


Did you graduate?
Yes
No

College #1

Name

Address

Highest Degree Obtained

Major

Minor

College #2

Name

Address

Highest Degree Obtained

Major

Minor

College #3

Name

Address

Highest Degree Obtained

Major

Minor

Professional Licenses #1

Name

State Issued


Expiration Date


Professional Licenses #2

Name

State Issued


Expiration Date


Professional Licenses #3

Name

State Issued


Expiration Date


List any other certifications or other specialties


MILITARY HISTORY

Are you a veteran?
Yes
No

Date Served From:


Date Served To:


List any special skills or training:




EMPLOYMENT HISTORY

Employer #1

Company Name


Phone Number


Address


City, State, Zip


Date Employed From


Date Employed To


Beginning Salary


Ending Salary


Job Title:


Supervisor`s Name & Title


May we contact this person?

Yes
No

Why not?

Describe Duties


Specific Reason for Leaving

Employer #2

Company Name


Phone Number


Address


City, State, Zip


Date Employed From


Date Employed To


Beginning Salary


Ending Salary


Job Title:


Supervisor`s Name & Title


May we contact this person?

Yes
No

Why not?

Describe Duties


Specific Reason for Leaving

Employer #3

Company Name


Phone Number


Address


City, State, Zip


Date Employed From


Date Employed To


Beginning Salary


Ending Salary


Job Title:


Supervisor`s Name & Title


May we contact this person?

Yes
No

Why not?

Describe Duties


Specific Reason for Leaving

Employer #4

Company Name


Phone Number


Address


City, State, Zip


Date Employed From


Date Employed To


Beginning Salary


Ending Salary


Job Title:


Supervisor`s Name & Title


May we contact this person?

Yes
No

Why not?

Describe Duties


Specific Reason for Leaving

How many jobs have you had in the last five years not listed above?


Why are you seeking a new position at this time?


List any business-related outside interests and organizations you’re active in



Please read the following carefully, then check accept and date the application.

I authorize this company to make an investigation of all information contained in this employment application and I release from liability all companies and corporations supplying such information. I understand any false answers, statements, or implications made by me on this application or other required documents shall be considered sufficient cause for denial of employment or discharge. I specifically authorize and direct my current and former employers to supply employment-related information to this company and do hereby release my current and former employers from liability for providing information to this company. Upon termination of my employment for whatever reason, I release this company from all liability for supplying any information concerning my employment to any potential employer. I authorize this company, if applicable, to request a copy of my credit report, motor vehicle driving record, and any other investigative report deemed necessary through various third-party sources. As required by law, upon request within a reasonable period of time, I will be notified as to the nature and scope of such investigations. I hereby agree to submit to any drug test required, whether prior to my employment or if employed by this company at any time thereafter. If requested, I will take a postjob offer physical examination and my employment, in the event I receive medical treatment for any condition, including a physical, psychological, emotional, or psychiatric condition that is job-related, I hereby authorize the limited release and exchange of such medical information relating to my condition between the treatment provider and a company-designated physician. I further understand this is an application for employment and no employment contract is being offered. I understand that if I am employed, such employment is for an indefinite period of time and the company may change wages, benefits, and conditions at any time. My employment is at will. No individual with the company is authorized to change the employment-at-will status except an officer of the company, who may do so only in writing. I have read and agree to the above.


* I agree to the above statement.