Employment Application

🔒 For your security, do NOT enter your Social Security Number anywhere on this application. We will collect it in person only after an offer of employment.

Your contact information

First name *

Last name *

Email *

Phone *

Street address

City

State

Zip code

Position & availability

Position applying for *

Desired pay

Date available to start

Desired employment type

Availability (days / shifts you can work)

Eligibility

Are you legally authorized to work in the United States? *

Are you 18 years of age or older? *

Work history

Most recent first — up to three employers. Reminder: do not enter your Social Security Number.

Employer 1

Employer

Job title

Start (MM/YYYY)

End (MM/YYYY or Present)

Duties / responsibilities

Reason for leaving

May we contact this employer?

Employer 2

Employer

Job title

Start (MM/YYYY)

End (MM/YYYY or Present)

Duties / responsibilities

Reason for leaving

May we contact this employer?

Employer 3

Employer

Job title

Start (MM/YYYY)

End (MM/YYYY or Present)

Duties / responsibilities

Reason for leaving

May we contact this employer?

Education

Education level

Education detail

Licenses & certifications

Forklift certified

CDL holder

CDL class (if any)

Other licenses / certifications

References

Three references — supervisors, co-workers, teachers. Reminder: do not enter your Social Security Number.

Reference 1

Name

Relationship

Phone

Reference 2

Name

Relationship

Phone

Reference 3

Name

Relationship

Phone

Final details

How did you hear about us?

Resume (PDF or Word — optional)

Anything else you'd like us to know? (optional)

Certification

Do NOT include your Social Security Number. We will collect it in person only after an offer of employment.

I certify that the information provided on this application is true and complete to the best of my knowledge. *

Signature (type your full legal name) *