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Personal Information
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First name * | |
Middle initial * | |
Last name * | |
Address * | |
City * | |
State * | |
ZIP code * | |
Email * | |
Phone (with area code) * | |
Secondary/other phone (with area code) | |
Preferred method of contact | Email Phone |
Emergency contact and phone number (with area code) | |
Date of birth (mm/dd/yyyy) | |
Are you legally eligible for employment in the United States? * | Yes No |
Have you ever been convicted of any offenses or completed a period of incarceration within the past ten years? * | Yes No |
If yes, please explain | |
Have you ever been employed by The Windbreak? * | Yes No |
If you were employed for this company, during what time did this occur? | |
Were you referred to us? | Yes No |
If yes, please enter the referrer’s name | |
List any friends/relatives currently employed by The Windbreak | |
General Information
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Position for which you are applying * | |
Date you can start working * | |
Salary/wage you are seeking * | |
Which work schedule are you willing to accept? * | Full-time Part-time Temporary |
Days you are available to work | Monday Tuesday Wednesday Thursday Friday Saturday Sunday
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Education and Training
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What is the highest level of education you have completed? * | GED High school College Graduate school |
Name of high school | |
What is the highest grade level you completed in high school? | 9 10 11 12 |
Name of college | |
Work History
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Have you ever been employed before? * | Yes No |
Are you currently employed? * | Yes No |
If you are currently employed, may we contact your employer? | Yes No |
Name of current/most recent employer | |
City of current/most recent employer | |
Address of current/most recent employer | |
State of current/most recent employer | |
ZIP code of current/most recent employer | |
Phone (with area code) of current/most recent employer | |
Job title for current/most recent employer | |
Hours worked per week for current/most recent employer | |
What specific tasks did you complete for this job? | |
What machines/equipment did you operate for this job? | |
Date started for this employer | |
Date ended for this employer | |
Wage (per hour or pay period) for this job | |
Reason for leaving this job | |
Supervisor for current/most recent employer | |
How many other previous employers have you had? * | None One Two More than two |
Please summarize any other work history you have | |
References
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First name of reference 01 * | |
Last name of reference 01 * | |
Address of reference 01 * | |
City of reference 01 * | |
State of reference 01 * | |
ZIP code of reference 01 * | |
Phone (with area code) of reference 01. * | |
First name of reference 02 * | |
Last name of reference 02 * | |
Address of reference 02 * | |
City of reference 02 * | |
State of reference 02 * | |
ZIP code of reference 02 * | |
Phone (with area code) of reference 02 * | |
First name of reference 03 * | |
Last name of reference 03 * | |
Address of reference 03 * | |
City of reference 03 * | |
State of reference 03 * | |
ZIP code for reference 03 * | |
Phone (with area code) for reference 03 * | |
Additional Comments
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Additional comments | |
AgreementI certify that my answers are true and complete to the best of my knowledge. If this application leads to employment, I understand that false or misleading information in my application or interview may result in my release. I also authorize The Windbreak to make any investigation of my personal or employment history, and I also authorize any former employer, person, firm, corporation, or government agency to give The Windbreak any information they may have pertaining to me. In consideration of The Windbreak’s review of this application, I release The Windbreak and all providers of information from any liability as a result of furnishing and receiving this information.
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Agreement Acknowlegment
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Do you agree with the above statements? * | Yes, I do |