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 AfghanistanÅland IslandsAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRéunionRomaniaRussiaRwandaSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUS Minor Outlying IslandsUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabwe Country Have you lived at your current address for over two years?YesNoEducationHigh School* School Name City State / Province / Region Diploma*YesNoUndergraduate School School Name City State / Province / Region Grad Schol School Name City State / Province / Region Employment InformationPosition Applying For*Start Date* Date Format: MM slash DD slash YYYY Desired Salary*Desired Hourly Pay*Which do you prefer?*Full-TimePart-TimeCan 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?*YesNoHave you worked for this business before?*YesNoHave you received a description of the job or been made aware of the essential functions of the job for which you are applying?*YesNoDo you understand the job requirements?*YesNoAre you on layoff and subject to recall?*YesNoAre you currently bound by a non-competition, confidentiality or trade secret agreement?*YesNoHave you ever been discharged or asked to resign from a job?*YesNoHave you ever been convicted of or pled guilty to a felony or crime other than a minor traffic citation?*YesNoEmployment HistoryMay we contact your present employer?*YesNoEmployer 1 Company City State / Province / Region ZIP / Postal Code Start Date Date Format: MM slash DD slash YYYY End Date Date Format: MM slash DD slash YYYY Position HeldDutiesReason For LeavingEmployer 2 Company City State / Province / Region ZIP / Postal Code Start Date Date Format: MM slash DD slash YYYY End Date Date Format: MM slash DD slash YYYY Position HeldDutiesReason For LeavingJob-Related SkillsDo you have a valid driver's license?*YesNoHave you been convicted of or pled guilty to any traffic-related offense within the past five years?*YesNoHave you had your driver's license suspended or revoked or had your driving privileges modified by a court of law?*YesNoPlease 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 PhoneRelationshipReference 2 First Last PhoneRelationshipReference 3 First Last PhoneRelationshipApplicant'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.