(LIst tools of the trade you own such as hand truck, pager, iPhone)
Are You Employed Now
YesNo
Can you work Nights and Weekends
YesNo
What are your preferred hours
Authorized To Work In U.S.
YesNo
Are you able to lift 50 pounds e.g. a case of copy paper
YesNo
Have you ever had your driver license suspended or revoked
YesNo
Do You Have a Delivery Vehicle
YesNo
Color (required)
Education History
Did You Graduate High School
YesNo
Former Employers
(List below last four employers, starting with last one first also list dates worked, address of employers, and reason for leaving)
Have you ever been convicted of a crime? if yes explain below
YesNo
Please Explain
Authorization
"I certify that the facts contained in this application are true and complete to the best of my knowledge and understand that, if employed, falsified statements on this application shall be grounds for dismissal.
I authorize investigation of all statements contained herein and the reference and employers listed above to give you any and all in-formation concerning my previous employment and any pertinent information they may have, personal or otherwise, and release the company from al liability for any damage that may result from utilization of such information.
I also understand and agree that no representative of the company has any authority to enter into any agreement for employment for any specified period of time, or to make any agreement contrary to the foregoing, unless it is in writing and signed by an authorized company representative.
This waiver does not permit the release or use of disability-related or medical information in a manner prohibited by the Americans with Disabilities Act (ADA) and other relevant federal and state laws."
I agree to the terms above.
