Application for Employment
First name *
Last name *
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country—Please choose an option—United StatesUnited KingdomAustraliaCanadaFranceNew ZealandIndiaBrazil----AfghanistanÅland IslandsAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua & BarbudaArgentinaArmeniaArubaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia & HerzegovinaBotswanaBouvet IslandBritish Indian Ocean TerritoryBritish Virgin IslandsBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCape VerdeCaribbean NetherlandsCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos (Keeling) IslandsColombiaComorosCongo - BrazzavilleCongo - KinshasaCook IslandsCosta RicaCôte d’IvoireCroatiaCubaCuraçaoCyprusCzechiaDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard & McDonald IslandsHondurasHong Kong SAR ChinaHungaryIcelandIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacau SAR ChinaRepublic of North MacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmar (Burma)NamibiaNauruNepalNetherlandsNew CaledoniaNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestinian TerritoriesPanamaPapua New GuineaParaguayPeruPhilippinesPitcairn IslandsPolandPortugalPuerto RicoQatarRéunionRomaniaRussiaRwandaSamoaSan MarinoSão Tomé & PríncipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia & South Sandwich IslandsSouth KoreaSouth SudanSpainSri LankaSt. BarthélemySt. HelenaSt. Kitts & NevisSt. LuciaSt. MartinSt. Pierre & MiquelonSt. Vincent & GrenadinesSudanSurinameSvalbard & Jan MayenSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad & TobagoTunisiaTurkeyTurkmenistanTurks & Caicos IslandsTuvaluU.S. Outlying IslandsU.S. Virgin IslandsUgandaUkraineUnited Arab EmiratesUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamWallis & FutunaWestern SaharaYemenZambiaZimbabwe
Phone Number ### - ### - ####
Are you 18 years or older?YesNoPosition 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?YesNoIn good standing?YesNoState and License number: Have you ever been convicted of a felony?YesNoIf so, explain: Have you worked for this or any other vending company?YesNoIf so, where and when?YesNoDo you have computer experience?YesNoIf so, explain: Do you have any health restrictions that would apply to work on the job such as lifting requirements, driving restrictions, etc?YesNoIf so, explain: Are you currently employed?YesNoIf so, where? May we contact your current employer?YesNot at this time
High School: City: State —Please choose an option—AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming
Graduated:YesNoIf no, GED or years completed: If yes, year graduated: College: Years attended: Do you hold a degree?YesNoIf 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: