Employment Employment Form Address: 7892 Cherry Valley, Caledonia, MI 49316Phone: 616-891-9380 Personal InformationName* First Last Home Phone*Cell Phone*Email* AddressAddress* Street Address City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Have you lived at your current address for over two years? Yes No EducationHigh School* School Name City State / Province / Region Diploma* Yes No Undergraduate School School Name City State / Province / Region Grad School School Name City State / Province / Region Employment InformationPosition Applying For* Start Date* MM slash DD slash YYYY Desired Salary*Desired Hourly Pay*Which do you prefer?* Full-Time Part-Time Can you work...* Weekends? Evenings? When are you available?* Monday Tuesday Wednesday Thursday Friday Saturday Sunday When are you not available?Are you at least 18 years of age and legally eligible to work for our company in the United States?* Yes No Have you worked for this business before?* Yes No Have you received a description of the job or been made aware of the essential functions of the job for which you are applying?* Yes No Do you understand the job requirements?* Yes No Are you on layoff and subject to recall?* Yes No Are you currently bound by a non-competition, confidentiality or trade secret agreement?* Yes No Have you ever been discharged or asked to resign from a job?* Yes No Have you ever been convicted of or pled guilty to a felony or crime other than a minor traffic citation?* Yes No Employment HistoryMay we contact your present employer?* Yes No Employer 1 Company City State / Province / Region ZIP / Postal Code Start Date MM slash DD slash YYYY End Date MM slash DD slash YYYY Position Held Duties Reason For LeavingEmployer 2 Company City State / Province / Region ZIP / Postal Code Start Date MM slash DD slash YYYY End Date MM slash DD slash YYYY Position Held Duties Reason For LeavingJob-Related SkillsDo you have a valid driver's license?* Yes No Have you been convicted of or pled guilty to any traffic-related offense within the past five years?* Yes No Have you had your driver's license suspended or revoked or had your driving privileges modified by a court of law?* Yes No Please list all states from which you hold or held a driver's licensePlease list any special skills you may have that relate to the position applied forPlease list any professional licenses, designations, certifications, etc. that may relate to the position applied for. Include date granted, name of organization, and any other relevant information.ReferencesReference 1 First Last PhoneRelationship Reference 2 First Last PhoneRelationship Reference 3 First Last PhoneRelationship Applicant's Certification AgreementThe company and other persons or employers are released from all liability brought forth by any investigation resulting from my submission of this electronic application and the data contained here in. The information in this application is true and complete to the best of my knowledge. Any falsification, misrepresentation, or omission on this application can be cause for denial or termination of employment. If hired, my employment is voluntary, meaning that either party can terminate employment at any time for any reason. Upon acceptance of employment if a position is offered, I agree to abide by all existing and future company rules and regulations. The company reserves the right to change any working agreement as deemed necessary. Any employment offer is contingent upon my providing proof of identity and eligibility to work the country of employment.CAPTCHA
