Application for Employment
First name *
Last name *
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Phone Number ### - ### - ####
Are you 18 years or older? YesNo Position applied for: (Check all that apply) OfficeWarehouse TeamSet-Up/ Installation TeamMaintenance & RepairRoute/ Replenishment TeamSales PositionOther
If other, please describe:
Pay desired: Emergency Contact Name: Emergency Contact Phone Number: ### - ### - ####
Do you hold a driver's license? YesNo In good standing? YesNo State and License number: Have you ever been convicted of a felony? YesNo If so, explain: Have you worked for this or any other vending company? YesNo If so, where and when? YesNo Do you have computer experience? YesNo If so, explain: Do you have any health restrictions that would apply to work on the job such as lifting requirements, driving restrictions, etc? YesNo If so, explain: Are you currently employed? YesNo If so, where? May we contact your current employer? YesNot at this time
High School: City: State ---AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming
Graduated: YesNo If no, GED or years completed: If yes, year graduated: College: Years attended: Do you hold a degree? YesNo If so, what? Vocational training/ Other: What employment skills do you have that you believe would make you a good employee?
List most recent employers first.
Company #1: Address: Job Title: Reason for leaving: Dates of employment: Ending rate of pay: $
Company #2: Address: Job Title: Reason for leaving: Dates of employment: Ending rate of pay: $
Company #3: Address: Job Title: Reason for leaving: Dates of employment: Ending rate of pay: $
Company #4: Address: Job Title: Reason for leaving: Dates of employment: Ending rate of pay: $
U.S. Military Service: Branch: Rank: Date Entered: Date Discharged:
Give three references other than relatives.
Name: Address: Phone Number ### - ### - #### Name: Address: Phone Number ### - ### - #### Name: Address: Phone Number ### - ### - ####
I certify the information contained in this application is true and complete to the best of my knowledge. If information is found to be falsified, I understand this can be grounds for dismissal.
If an employment relationship is established I will have the right to terminate my employment at any time and the company will have a similar right. If hired, there is a 90 day probationary period. I authorize checking all statements contained in this application including references in order to give information, personal or otherwise, and release the company from all liability for any damage that may result from use of such information.
If I am hired to drive a company vehicle, I understand that any offer of employment is contingent upon acceptance of my driver's license Motor Vehicle Report by the company's insurance carrier.
I understand that any offer of employment is contingent upon obtaining a negative drug screen result within 72 hours of employment, a negative TB test, and an acceptable background check to which the company shall be the sole determiner. Should I terminate my employment with Fox Vending in less than 90 day of my hire date, I agree to have the cost of the pre-employment drug screening,TB test, and criminal background check deducted from my final check.
Fox Vending does not discriminate in hiring or employment on the basis of race, religion, national origin, gender, age, veteran status, marital status, or disability. No question on this application is intended to secure information to be used for such discrimination.
Date: Applicant's Signature:
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