Date

Position applied for

How did you hear of this opening?

When can you start? Desired Wage $

Are you a U.S. citizen or otherwise authorized to work in the U.S. on an unrestricted basis? (You may be required to provide documentation.) Yes  No

Are you looking for full-time employment? Yes   No

If no, what hours are you available?

Are you able to stand for prolonged periods of time? Yes   No

Are you able to bend? Yes   No

Can you lift 40 pounds? Yes   No

Can you push and pull weighted/wheeled carts? Yes   No

Can you work in an environment that is not air-conditioned? Yes   No

Can you work where lint is airborne? Yes   No

Are you willing to work swing shift? Yes   No

Are you willing to work graveyard? Yes   No

Have you ever been convicted of a crime:
(This will not necessarily affect your application.)   yes no
If yes, please explain:

Education      

In addition to your work history, are there other skills, qualifications, or experience that we should consider?

Employment History             (Start with most recent employer)

Reason for leaving:

List the jobs held, duties performed and skills used or learned:

May we contact your employer: yes no

Reason for leaving:

List the jobs held, duties performed and skills used or learned:

May we contact your employer: yes no

Reason for leaving:

List the jobs held, duties performed and skills used or learned:


May we contact your previous employer: yes no

LIST REFERENCES OTHER THAN RELATIVES AND PREVIOUS EMPLOYERS:

Use this space to add any additional information necessary to describe your full qualifications for the position which you are applying for:


As part of our company policy we may perform a criminal background check on someone we are considering for employment. Would you agree to a criminal background check: yes no

Have you worked with this company before: yes no

I certify that the facts set forth in this application for employment are true and complete to the best of my knowledge. I understand that if I am employed, false statements on this application shall be considered sufficient cause for dismissal. This company is hereby authorized to make any investigations of my prior educational and employment history.

I understand that employment at this company is “at will,” which means that either I or this company can terminate the employment relationship at any time, with or without prior notice, and for any reason not prohibited by statute. All employment is continued on that basis. I understand that no supervisor, manager, or executive of this company, other than the president, has any authority to alter the foregoing.

Attach additional information if necessary.