Application for Employment2 - N-Stock Box

Application for Employment

Please complete all applicable information fields.

N-Stock Box is an equal opportunity employer.

Personal Data

Last Name* First Name* Middle Name/Initial Present Street Address* City* State* Zip* Email Address Cell Phone* Daytime Phone* Alternate Phone

Job Interests

Position you are applying for: Type of employment desired:* Expected pay level: How did you learn of this job position? How you ever worked for N-Stock Box?* If "Yes" please state when and where you worked for the company in the past. Are you available for shift work?* Are you available for weekend work?* Are you available to work overtime if necessary?* Please indicate any work hours/days you are unavailable. List any relatives now employed in any part of the company.

Most Recent or Current Employment History

Are you currently employed?* If so, may we contact your current employer?* Name of current or most recent employer: Telephone number: Type of business: Name of supervisor or manager: Address and street City and State Start Date: End Date: Final pay Your job position and duties: Reason for leaving:

Next Most Recent Employment History

Name of current or most recent employer: Telephone number: Type of business: Name of supervisor or manager: Address and street City and State Start Date: End Date: Final pay Your job position and duties: Reason for leaving: May we contact this employer for a reference?

Next Most Recent Employment History

Name of current or most recent employer: Telephone number: Type of business: Name of supervisor or manager: Address and street City and State Start Date: End Date: Final pay Your job position and duties: Reason for leaving: May we contact this employer for a reference?

Next Most Recent Employment History

Name of current or most recent employer: Telephone number: Type of business: Name of supervisor or manager: Address and street City and State Start Date: End Date: Final pay Your job position and duties: Reason for leaving: May we contact this employer for a reference?

Next Most Recent Employment History

Name of current or most recent employer: Telephone number: Type of business: Name of supervisor or manager: Address and street City and State Start Date: End Date: Final pay Your job position and duties: Reason for leaving: May we contact this employer for a reference?

Next Most Recent Employment History

Name of current or most recent employer: Telephone number: Type of business: Name of supervisor or manager: Address and street City and State Start Date: End Date: Final pay Your job position and duties: Reason for leaving: May we contact this employer for a reference?

Periods of Unemployment

Please account for all periods of unemployment lasting a month or more since you left school.

Time Period: What were you doing during this time? Time Period: What were you doing during this time? Time Period: What were you doing during this time? Time Period: What were you doing during this time?

References

List below two persons not related to you who have knowledge of your job performance and work habits during some part of the past five years.

Name:*

Telephone number:*

Address:

Occupation:

How do you know this individual?

Number of years acquainted:

Name:*

Telephone number:*

Address:

Occupation:

How do you know this individual?

Number of years acquainted:

Background Information

If hired, would you have a reliable means of transportation to and from work?* If hired, can you present evidence of your U.S. citizenship or your right to live and work in this country?* Are you able to perform the essential functions of the job for which you are applying, with or without a reasonable accommodation?* If "No" please describe any job junctions that cannot be performed.

Other Background Information

Have you ever been convicted of a felony at any time in the past?* Have you ever been convicted of, or entered into a pretrial diversion program or deferred adjudication for, an offense involving dishonesty or breach of trust (examples:theft, bad checks, embezzlement, forgery, perjury, tax fraud, etc.)?* Have you ever been convicted of, or entered into a pretrial diversion program or deferred adjudication for, an offense involving the manufacture, possession, or sale of illegal drugs?* Other than a traffic citation, are you presently involved in any criminal law proceedings of any type (examples:pending criminal charges, outstanding arrest warrant, out of jail on bond, awaiting criminal trial, etc.)?* Are you presently subject to any court order that restricts your activities or ability to interact with any persons?* If you answered "Yes" to any of the 5 questions above, please describe the matter below, indicating what, where, when and the nature of the offense or issue. [Note: a "Yes" answer is not an automatic disqualification. All factors will be considered.]

Acknowledgements and Signature

Read each paragraph below and initial after you have read it. Then type your name at the bottom as signature indicating your agreement.

I certify that I have not withheld any information that might adversely affect my chances for employment with the company. I further certify my understanding that any omission or false statement in this application will be grounds for rejection of this application, or for later discharge if I am hired, regardless of the time elapsed before discovery.* I authorize the company to investigate my references, work record, education, and other matters as it believes necessary to determine my suitability for employment, and I authorize the companies and individuals listed in this application to furnish the company all requested information about my work habits, accomplishments, and character without further notice to me. I release all such companies and individuals from any claims or liabilities based on information they furnish to the company.* I understand that nothing in this application, and nothing told to me during the hiring process, creates an employment contract between the company and me. I understand and agree that if I am employed, my employment will not be for a fixed period of time and me be terminated, with or without notice or cause, at the option of either the company or me at any time, and that no contrary promises or representations are binding on the company unless made in writing and signed by both an authorized representative of the company and me.* Applicant Signature* Today's Date* Enter the security code:

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