FIRLAND WORKSHOP–APPLICATION FOR EMPLOYMENT

“Developing People While Defeating TB”

 An Equal Opportunity Employer—
“Persons with disabilities encouraged to apply”

(Application will remain on file for 12 months)

Position applied for
Referral source    Friend   Web site   Job agency    Other

APPLICANT INFORMATION

First name
Last name
Email
Phone
   
Address 1
Address 2
City
State ex: WA
Zip

Are you at least 18 years of age?  Yes    No

Are you a U.S. Citizen or legally authorized to work in the U.S.?   Yes   No

Date you are able to start work:

May we contact your current employer?  Yes   No

Contact info for current employer:

Name
Phone

Are you on layoff status or subject to recall elsewhere?   Yes    No

Do you smoke?  Yes    No

Have you previously applied with us?  Yes   No

Pay Expected: $ per

If hired, how long do you plan to continue working for the company?

Have you previously worked with us?   Yes   No
If so, when?

Are any of your records under a different name?  Yes    No
If so, what name?

Do you have any relatives working for us?   Yes    No

Do you wish to work:  Full-time    Temporary

Are you willing and available to work:  Days   Evenings

Overtime
Part-time
Nights
   Weekends
   On call
   Holidays

If applying for a job that requires one, do you have a valid driver’s license?   Yes    No

Is there any reason you might be unable to meet our attendance requirements?   Yes   No
If yes, please explain:

EDUCATION / TRAINING
Include name and location of schools, did you graduate/# of years, and subjects studied          

High School:


College 


Other Training (particularly that led to license or certification)

Are you taking or do you plan to take any additional education?  Yes   No
If so, what?

SKILLS / ABILITIES:
List any machines you are skilled in using:

List any skills or abilities you have which are pertinent to the position, including hobbies or related interests:

JOB REQUIREMENTS
Will you be able to perform the essential functions of the job as described in the job posting, with or without reasonable accommodation?     
Yes    No

Special accommodations that might be required?

PLEASE LIST WORK EXPERIENCE, INCLUDING MILITARY AND VOLUNTEER EXPERIENCE
Present or Last Employer

Company
Address
Phone
Start date
Leaving date
Supervisor
Rate of pay
Job Title & Duties
Why did you leave?

PERSONAL REFERENCE

Full name
Phone
Address
Occupation
How long known

PLEASE READ EACH OF THE FOLLOWING ITEMS BEFORE SUBMITTING THIS APPLICATION
1.   As a final step in the hiring process, an applicant may be subject to an employment entrance exam that may include screening for illegal drugs. Applicants who confirm positive on drug screening will not be considered for employment. If a job offer is made, it may be made contingent upon the successful passing of a physical.
2.   I CERTIFY that the facts contained in this application are true and complete, and understand that if employed, false, misleading or incomplete statements on this application shall be grounds for immediate dismissal.
3.   I AUTHORIZE the company to investigate and verify any information contained in my application or pre-hire interviews, including my previous employment, education and background. I further release all parties from all liability for any damage that may result from furnishing or receiving such information.
4.   I UNDERSTAND and agree that my employment and compensation may be terminated at any time without prior notice, with or without reason, at the option of the company or myself, and understand that no representative of the company, other than the President, has authority to enter into any agreement contrary to the foregoing.
5.   I UNDERSTAND that all company property must be returned and any indebtedness to the company must be paid on or before my last day of work. I authorize the company to deduct from my final paycheck an amount necessary to satisfy any unpaid obligation.

I agree to the terms and conditions listed above and that all information entered is accurate.

Date: 05/27/2017