Fields marked with an * are required
If under the age of 18, can you produce the necessary work certificate at the time of employment?
Type of employment desired
Are you willing to work overtime?
Have you previously applied for employment with this Company?
Have you ever been employed by this company
INSTRUCTIONS FOR ANSWERING THE NEXT TWO QUESTIONS:
- Hawaii applicants: Do not answer the following two questions.
- District of Columbia and Washington applicants: Limit any response to the past ten (10) years.
- Utah applicants: Limit any response to felony convictions only.
- Arizona, District of Columbia, Illinois, Missouri, Rhode Island, and Utah applicants: Do not respond to second question regarding arrests.
- California applicants: Do not include misdemeanor marijuana-related convictions that are more than two (2) years old or misdemeanor convictions for which probation was successfully completed or otherwise discharged and the case was judicially dismissed.
- Massachusetts applicants: Limit any response regarding misdemeanor convictions to the last five (5) years and to those which were not a first offense for drunkenness, simple assault, speeding, a minor traffic violation or disturbing the peace. Applicants with a sealed record on file with the Massachusetts Commissioner of Probation may answer “No Record” with respect to: 1) all inquiries relating to prior convictions or arrests; 2) misdemeanor convictions older than five (5) years; and 3) first time convictions for simple assault, drunkenness, speeding, minor traffic violations or disturbing the peace.
- North Dakota and Oregon applicants: Regarding arrests, limit your response to pending charges that are less than one (1) year old.
- Indiana applicants: Regarding arrests, limit your response to pending charges for felonies and class A misdemeanors that are less than one (1) year old.
- Michigan applicants: Regarding arrests, limit your response to felony arrests awaiting conviction or dismissal.
- Connecticut applicants: You are not required to disclose the existence of any arrest, criminal charge, or conviction, the records of which have been erased. Criminal records subject to erasure are records pertaining to finding of delinquency or the fact that a child was a member of a family with service needs, an adjudication as a youthful offender, a criminal charge that has been dismissed or nolled (not prosecuted), a criminal charge for which the person was found guilty, or a conviction for which the offender received an absolute pardon. Any person whose criminal records have been erased is deemed to have never been arrested within the meaning of the law as it applies to the particular proceedings that have been erased, and may so swear under oath.
- New York applicants: An ex-offender who is denied employment may, upon written request, receive a statement of the reason(s) for denial within 30 days of the applicant’s request for such information.
- All applicants: Do not include convictions that were sealed, eradicated, erased, annulled by a court, or expunged, or convictions that resulted in referral to a diversion program.
Have you ever plead guilty or no contest to, or been convicted of any criminal offense other than the applicable exceptions listed above?
Have you ever been arrested for any matters for which you are out on bail or on your own recognizance pending trial?
CRIMINAL OFFENSES ONLY: If you answered Yes, to either of the above two questions, please provide the date(s) and explain in accordance with the above instructions so that individual circumstances can be considered.
Criminal convictions or arrests will not automatically disqualify an applicant from a particular job. The Company will consider the nature of the crime, its seriousness, whether the conviction(s) substantially relates to the position’s functions and qualifications, the frequency of convictions, the applicant’s age at the time of the conviction, the time elapsed since the date of the conviction or completion of jail sentence, the applicant’s entire work and educational history, and employment references and recommendations.
Have you ever initiated an act of violence in the workplace?
Bus./Tech./Trade or Post College
WORK EXPERIENCE: Please list the names of your present of previous employers in chronological order with present or last employer listed first. Please account for all periods of time including any period of unemployment. If self-employed, please supply firm name and business references. You may include any verifiable work performed on a volunteer basis, internships, or military service. Your failure to completely respond to each inquiry may disqualify you for future consideration from employment.