Application

Job Applied For*

Location*

Today's Date*

Are You Seeking*

When could you start work?*

Full Name*

Phone*

Email*

Address*

Street Address Address Line 2 City State ZIP Code

Are you able to lift up to 75 lbs on a consistent basis?*

Yes
No

Are you 18 years of age or older?*

Yes
No

If hired, can you furnish proof you are eligible to work in the U.S.?*

Yes
No

Have you ever applied here before?*

Yes
No

If yes, when?

Were you ever employed here?*

Yes
No

If yes, when?

Have you ever been convicted of any law violation (except a minor traffic violation)?*

Yes
No

If yes, give details.

Are you now or do you expect to be engaged in any other business or employment?*

Yes
No

If yes, please explain.

For Driving Jobs Only

Do you have a valid driver's license?

Yes
No

Driver's License Number

What State was your Drivers License issued?

Have you had your drivers license suspended or revoked in the last 3 years?

Yes
No

If yes, give details.

List professional, trade, business or civic activities and offices held. (Exclude labor organizations and memberships which reveal race, color, religion, national origin, sex, age, disability or other protected status.)

EEOC

Invitation to Self Identify*

I am a protected veteran
I am not a veteran
I wish not to disclose

Voluntary Self Identification of Disability - Disability Status*

Yes, I have a disability
No, I don't have a disability
I don't wish to answer

Gender*

Male
Female

Applicant Affirmative Action Information*

Hispanic or Latino - A person of Cuban, Mexican, Puerto Rican, South or Central American, or Other Spanish culture or origin, regardless of race.
White - Not of Hispanic Origin - a person having origins in any of the original peoples of Europe, the Middle East, or North Africa.
Black or African American - Not of Hispanic Origin - A person having origins in any of the black racial groups of Africa.
Asian - A person having origin in any of the original people of the Far East, Southwest Asia, or the Idian subcontinent including, for example Cambodia, China, India, Japan, Korea, Malaysia, Pakistan, the Philippine Islands, Thailand, and Vietnam.
American Indian or Alaskan Native - A person having origins in any of the original peoples of North and South American (including Central America), and who maintains tribal affiliation or community attachment.
Native Hawaiian or Other Pacific Islander - A person having origins in any of the original peoples of Hawaii, Guam, Samoa, or other Pacific Islands.
Two or More (not Hispanic or Latino) - All persons who identify with more than one of the above five races.
I elect not to identify

List Name and Address of Schools

High School or GED

College or University

Vocational or Technical

What skills or additional training do you have that relate to the job for which you are applying?

What machines or equipment can you operate that relate to the job for which you are applying?

How did you hear about this job opening? (i.e., jetCenters Employment Website, Indeed, Connecting Colorado, etc...)

Past and Present Employment

List name of employers in consecutive order with present or last employer listed first. Account for all periods of time including military service and any periods of unemployment. If self-employed, give firm name and supply business references.

Name of Employer*

Address of Employer*

Street Address City State ZIP Code

Supervisor*

First Last

Phone*

Job Title and Duty*

Start Date*

End Date

Reason For Leaving*

Have you worked or attended school under any other name?*

Yes
No

If yes, give names.

Are you presently employed?*

Yes
No

If yes, may we contact your present employer?

Yes
No

Have you ever been fired from a job or asked to resign?*

Yes
No

If yes, please explain.

References

First Reference

Name

First Last

Address

Street Address City State ZIP Code

Phone

Second Reference

Name

First Last

Address

Street Address City State ZIP Code

Phone

Third Reference

Name

First Last

Address

Street Address City State ZIP Code

Phone

Upload Cover Letter

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Upload Resume

Accepted file types: jpg, png, gif, pdf, doc, docx, xls, Max. file size: 32 MB.

PLEASE READ EACH STATEMENT BEFORE AGREEING*

I verify I have read the below statement and agree.

I certify that all information provided in this employment application is true and complete. I understand that any false information or omission may disqualify me from further consideration for employment and may result in my dismissal if discovered at a later date.

I understand that the employer may request an investigative consumer report from a consumer reporting agency. This report may include information as to my character, reputation, personal characteristics and mode of living obtained from interviews with neighbors, friends, former employers, schools and others. I understand I have a right to make a written request within a reasonable time for the disclosure of the name and address of the consumer reporting agency so that I may obtain a complete disclosure of the nature and scope of the investigation.

I authorize the investigation of any or all statements contained in this application and also authorize any person, school, current employer (except as previously noted), past employers and organizations named in this application to provide relevant information and opinions that may be useful in making a hiring decision. I release such persons and organizations from any legal liability in making such statements.

I understand that if I am extended an offer of employment it may be conditioned upon my successfully passing a complete pre-employment physical examination. I consent to the release of any or all medical information as may be deemed necessary to judge my capability to do the work for which I am applying.

I understand I may be required to successfully pass a drug screening examination. I hereby consent to a pre- and/or post-employment drug screen as a condition of employment, if required.

I UNDERSTAND THAT THIS APPLICATION OR SUBSEQUENT EMPLOYMENT DOES NOT CREATE A CONTRACT OF EMPLOYMENT NOR GUARANTEE EMPLOYMENT FOR ANY DEFINITE PERIOD OF TIME. IF EMPLOYED, I UNDERSTAND THAT I HAVE BEEN HIRED AT THE WILL OF THE EMPLOYER AND MY EMPLOYMENT MAY BE TERMINATED AT ANY TIME, WITH OR WITHOUT CAUSE AND WITH OR WITHOUT NOTICE.

I have read, understand, and by my signature consent to these statements.

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Phone

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Application For Employment

For Driving Jobs Only

EEOC

List Name and Address of Schools

Past and Present Employment

References