Application for Employment StateAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareFloridaGeorgiaHawaiiIdahoIllinois IndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontana NebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvania Rhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming How were you referred to this company? (choose one): By your collegeBy an employeeAdvertisementEmployment AgencyWalk-inOther Educational History High School Graduated? yesno College Graduated? yesno Technical/trade school after high school Graduated? yesno Other education/training Graduated? yesno Outside Activities (exclude those indicating race, color, religion, sex, national origin, age, handicap, or Vietnam-era veteran status) Special Skills (check all that apply) Typing: yesno Computer Skills: hardwaresoftware Telephone Experience: yesno Miscellaneous Days and hours available – please check all that apply & fill in specific hours including a.m. or p.m: part time full time Mondays: available Tuesdays: available Wednesdays: available Thursdays: available Fridays: available Were you previously employed by this company? yesno Do you have any relative(s) currently employed by this company? yesno Have you been convicted of any crimes other than minor traffic violations during the past seven years? (a conviction record will not necessarily bar you from employment) yesno We will ask you to provide documentation of authorization to work if you are offered a position. Are you authorized to work in the United States? yesno Can you perform the essential functions of the job with or without reasonable accommodation? yesno U.S. Military Record Present military affiliation: nonereserve (active)reserve (inactive) Employment Record Starting with present or most recent, list your last three employers. Include self-employment and summer and part-time jobs. Dates worked May we contact your present employer? yesno I hereby certify that the answers and other information on this application are true and correct and that I understand any misrepresentation or omission of facts on my part will be justification for separation from the company's service, if employed. I understand that my employment is contingent upon proof of my authorization to work in the United States. I understand that my employment, if a position is offered, will be "AT-WILL," SUBJECT TO TERMINATION AT ANY TIME BY EITHER THE COMPANY OR ME FOR ANY REASON.