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lABORER Application For Employment

(Pre-Employment Application Questionnaire) (An Equal Opportunity Employer)

6622 112TH E. | Puyallup, WA 98373 | 1(888)565-5665 | Fax 253-435-5788

In compliance with Federal and State equal opportunity laws, qualified applicants are considered for all positions without regard to race, color, religion, sex, national origin, age, marital status, veteran status, non-job disability, or any other protected group status.

Date *
Date
Last, First, Middle
***-**-****
Present Address *
Present Address
Phone Number *
Phone Number
Are you 18 years or older? *
Are you prevented from lawfully becoming employed in this country because of visa or immigration status? *
Employment Desired
Date you can start. *
Date you can start.
Are you employed now? *
If so, can we inquire of your present employer?
Have you ever applied to this company before? *
If yes, When?
If yes, When?
Education
Address
Address
Did You Graduate?
Address
Address
Did you graduate?
Address
Address
Did you graduate?
Address
Address
Did you graduate?
Exclude organizations, the name of which indicates the race, creed, sex, age, marital status, color or nation of origin of its members
Branch
Former Employers
List below three employers, from present
From
From
To
To
Address
Address
From
From
To
To
Address
Address
From
From
To
To
Address
Address
References
Give the names of three persons not related to you, whom you have known for at least one year
Address
Address
Address
Address
Name
Address
Address
Emergency Contact Info
Phone
Phone
Address
Address
I CERTIFY THAT ALL THE INFORMATION SUBMITTED BY ME ON THIS APPLICATION IS TRUE AND COMPLETE, AND I UNDERSTAND THAT IF ANY FALSE INFORMATION, OMISSIONS, or MISREPRESENTATIONS ARE DISCOVERED, MY APPLICATION MAY BE REJECTED AND, IF I AM EMPLOYED. MY EMPLOYMENT MAY BE TERMINATED AT ANY TIME. IN CONSIDERATION OF MY EMPLOYMENT, I AGREE TO CONFORM TO THE COMPANY'S RULES AND REGULATIONS, AND i AGREE THAT MY EMPLOYMENT AND COMPENSATION CAN BE TERMINATED, WITH OR WITHOUT NOTICE, AT ANY TIME, AT EITHERMY OR THE COMPANY'S OPTION. I ALSO UNDERSTAND AND AGREE THAT THE TERMS AND CONDITIONS OF MY EMPLOYMENT MAY BE CHANGED, WITH OR WITHOUT CAUSE, AND WITH OR WITHOUT NOTICE, AT ANY TIME BY THE COMPANY. I UNDERSTAND THAT NO COMPANY REPRESENTATIVES , OTHER THAN IT'S PRESIDENT, AND THEN ONLY WHEN IN WRONG AND SIGNED BY THE PRESIDENT, HAS ANY AUTHORITY TO ENTER INTO ANY AGREEMENT FOR EMPLOYMENT FOR ANY SPECIFIC PERIOD OF TIME, OR MAKEANY AGREEMENT CONTRARY TO THE FOREGOING.
I have read, understand and agree with the above paragraph *
Full Name
Date *
Date
This form has been revised to comply with the provisions of the Americans with Disabilities Act and the final regulations and interpretive guidance promulgated by EEOC on July 26. 1991.