Applicants are considered for all positions without regard to race, color, sex, creed, religion, national origin, age, marital or veteran status or the presence of a non-job related medical condition or disability, handicap, or sexual preference.
DATE
Name(Last name First)
Social Security No
Present Address
City
State Select One Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District Of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming
Zip Code
Permanent Address
Phone Number
Secondary Phone Number
Referred By
Have you ever been convicted of a felony? Yes No If yes, explain:
Are you on a layoff? Yes No
Are you subject to recall? Yes No
Person to be notified in case of an emergency
Name
Telephone #:
Plant Select Plant Craftline Kappa Graphics Times Printing
Position
Date You Can Start
Salary Desired
Are You Employed Now? Yes No
If So, May We Inquire Of Your Present Employer? Yes No
Ever Applied To This Company Before? Yes No
Where
When
Shifts available 1st 2nd 3rd
Will you work weekends? Yes No
Will you work overtime? Yes No
Are you applying for: Full Time Part Time
If under 18, can you furnish a work permit? Yes No
Permit #:
Have you ever worked for us before? Yes No
If yes, when?
Reason for leaving:
Continuing Education:
Describe all skills that would be of benefit in the job for which you are applying. (Example: Equipment or machines you’ve operated and for how long; computer software that you’ve used; any foreign languages you speak; supervising experience; special certifications you hold, etc.)
Most Recent Employment First
List employer you do not want us to contact: Reason:
Service Record
Duties and Special Training
Branch of Service:
Active Duty:
Date of Discharge:
Rank at Discharge:
Do you understand the Company’s description of the essential tasks of the job for which you are applying? Yes No
Are you able to perform the essential functions of the position for which you are applying with or without an accommodation? With an Accommodation Without an Accommodation
If you will need an accommodation, please describe the accommodation(s):
Applicant’s Signature:
Read carefully before signing.
I understand that all statements made on my application for employment are subject to verification. I, therefore, authorize investigation of all statements contained in my application regarding prior employment and education and hereby authorize any former employer or school that I attended which is not listed on my application to give you any information regarding my prior work performance and employment or education, whether or not such information is in its files or records, or provided by personal recollection. In consideration of your review of my application for employment, I agree that any former employer or school, its officers, agents, and employees, or anyone else providing information is hereby released and forever discharged from any liability whatsoever in connection with the disclosure of that information. I authorize you to contact the personal references listed in my application whom I also release and forever discharge from any liability whatsoever for providing information about me to you. I authorize use of photocopies of this original document to be used in securing references.
Print Name:
Social Security Number:
In order to facilitate our receiving reference information, please indicate below if you used a different name during any former employment or while attending school.
Print Former Name:
Sign Former Name:
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