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Employment Application
Equal Access to programs, services, and employment is available to all persons. Those applicants requiring reasonable accommodation to the application and/or interview process should notify a representative of the Human Resources Department.

Please fill this out as completely as possible to ensure proper handling of your job application.

Name:
Position(s) applied for or type of work desired:
Address:
City: State: ZIP:
Phone: --
E-mail Address:
Type of employment desired: Full-Time Part-Time Temporary
Date you will be available to work:
Are you able to meet attendance requirements? Yes No
Do you have any objection to working overtime if necessary? Yes No
Can you travel if required by this position? Yes No
Have you ever been previously employed by Alternative Hose? Yes No
Can you submit proof of legal employment authorization and identity? Yes No
If you're under 18, can you furnish a work permit if required? Yes No
Have you been convicted of a crime in the last seven years? Yes No
If yes, please explain (a conviction will not automatically bar you from employment):
How were you referred to us?

Employment History
Please provide all employment information for your past four employers starting with the most recent.

Employer:
Position held:
Address: City: State: ZIP:
Immediate supervisor and titie:
Dates employed: From to
Salary:
Job summary:
Reason for leaving:

Employer:
Position held:
Address: City: State: ZIP:
Immediate supervisor and titie:
Dates employed: From to
Salary:
Job summary:
Reason for leaving:

Employer:
Position held:
Address: City: State: ZIP:
Immediate supervisor and titie:
Dates employed: From to
Salary:
Job summary:
Reason for leaving:

Employer:
Position held:
Address: City: State: ZIP:
Immediate supervisor and titie:
Dates employed: From to
Salary:
Job summary:
Reason for leaving:

Other Skills and Qualifications
Summarize any job-related training, skills, licenses, certificates and/or other qualifications:


Education History
High School -- Name:
City: State:
Years completed: Course of study:
Did you graduate? Yes No

College -- Name:
City: State:
Years completed: Course of study:
Did you graduate? Yes No
Degree earned:

Technical School -- Name:
City: State:
Years completed: Course of study:
Did you graduate? Yes No
Certification(s) earned:

References
Please provide three references. Do not include relatives or employers.

Reference 1:
Phone: -- Years Known:

Reference 2:
Phone: -- Years Known:

Reference 3:
Phone: -- Years Known:

I hereby authorize the potential employer to contact, obtain, and verify the accuracy of information contained in this application from previous employers, educational institutions and references. I also authorize the potential employer to run a background check if they so choose. Furthermore, I hereby release from liability the potential employer and its representatives for seeking, gathering, and using such information to make employment decisions and all other persons or organizations for providing such information.

I understand that any misrepresentation or material omission made by me on this application will be sufficient cause for cancellation of this application or immediate termination of employment if I am employed, whenever it may be discovered.

If I am employed, I acknowledge that there is no specified length of employment and that this application does not constitute an agreement or contract for employment. Accordingly, either I or the employer can terminate the relationship at will, with or without cause, at any time, so long as there is no violation of applicable federal or state law.

I understand that it is the policy of this organization not to refuse to hire or otherwise discriminate against a qualified individual with a disability because of that person’s need for a reasonable accommodation as required by the ADA.

I also understand that if I am employed, I will be required to provide satisfactory proof of identity and legal work authorization within three days of being hired. Failure to submit such proof within the required time shall result in immediate termination of employment.

By clicking the button below, you represent and warrant that you have read and fully understand the foregoing, and that you seek employment under these conditions.





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