Personal
Information
Position
Applied for: Date of Application:
How
Did You Learn About Us?
Last Name: First Name: Middle Name (Initial):
Street: City: State: Zip Code:
County: Telephone
Number(s): Social Security Number:
If you are
under 18 years of age, can you provide required proof of your
eligibility to work? Yes No
Have you
ever filed an application with us before? Yes No
If
Yes, give date
Have you ever been employed with
us before?
Yes No
If
Yes, give date
Are you currently employed?
Yes No
May we contact your present
employer?
Yes No
Are you legally eligible to
become employed in the United States?Proof of citizenship or immigration status will be required
upon employment.
Yes No
On what date would you be
available for work?
Shift Preference:
First Second Third
Are you regularly available to
work:
Full
Time Part
Time Any
Shift
Weekends Overtime
Are you currently on
"lay-of" status and subject to recall?
Yes No
Have you plead guilty to, plead
no contest to, or been convicted of a crime other then a
driving-related misdemeanor within the last 10 years?An affirmative answer will not necessarily bar you from
employment.
Yes No
If Yes, please explain:
We are an Equal Opportunity
Employer
Education
List professional , trade,
business, or civic activities and offices held.You may exclude memberships which would reveal race, color,
religion, sex, national origin, ancestry, age, disability, or
other legally protected status:
References
Give the name, address, and
telephone number of three references who are not related to you
and are not previous employers.
Reference
1 - Name: Address: Telephone
Number:
Reference
2 - Name: Address: Telephone
Number:
Reference
3 - Name: Address: Telephone
Number:
Answer
this question only after reviewing a description of the job(s)
applied for:
Are
you able to perform the functions of the job(s) for which you
are applying without without accommodation? Yes No
Employment
Experience
Include
all employment since you left high school. Start
with your present or most recent job.
Include military assignments. You may include volunteer
activities, but you are not required to include any activities
which indicate race, color, religion, sex, national origin,
ancestry, disability or other legally protected status.
Have
you ever been discharged or involuntarily terminated from any
employment? Yes No
If
Yes, please explain and give the employer's telephone number and
address.
Skills
and Training
Describe
special job-related skills and qualifications acquired from
employment of other experience.
Describe
your qualifications acquired from employment or other
experiences.
List
the types of equipment or machinery you can operate and describe
your level of proficiency.
Have
you ever had any job-related training in the United States
military? Yes No
If
Yes, please describe
Applicant's
Certification
I
understand that this is an APPLICATION for employment and does
not now/ever constitute an express or implied contract between
the Company and me. I understand as a prospective employee
I may be required to complete a series of pre-employment tests
and a physical examination, which includes a drug and alcohol
screen and any offer of employment is contingent upon the
results of these examinations. By pressing submit below, I
state that all information supplied by me on this application
for employment is true, and gives EPIC Technologies permission
to check any and all information stated. I understand that
any falsification, misrepresentation or omission of facts in
this application will disqualify me from further consideration
or, if I am hired, will be sufficient cause for my immediate
dismissal.
