Application for Employment

Step 1 of 8

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Your Personal Information

Your Name

First Middle Last

Address

Street Address City State Zip

Email Address

Home Phone Number

Cell Phone Number

Are there other names under which you have worked or attended school?

If yes, please list for reference checking purposes.

Yes

Have you lived outside of Wisconsin in the last 10 years?

If yes, please list for out-of-state background checking purposes.

Yes

Are you legally authorized to work in the United States?

If hired, you will be required to provide proof of work authorization.

Yes

Are you at least 18 years old?

If not, your employment will be subject to verification that you meet state/federal minimum age requirements for the type of work you are applying for an have obtained a valid work permit, if necessary.

Yes

Have you ever applied at this company before?

Yes

If yes, when?

Have you ever worked at this company before?

Yes

If yes, when?

Position Information

Date Available to Start

Shift Preference

1st

2nd

3rd

Position Applying For

Status Preference

Full-Time

Part-Time

In-House-Pool / As-Needed

Weekend Only

Weekends Acceptable?

Yes

Salary/Wage Preference

How were you referred to the company?

Job Board

Social Media

School

Friend/Relative

Please specify

Employment History

List all employers starting with your present or most recent employer. Information provided should be accurate and complete. DO NOT WRITE “SEE RESUME”.

Name of Employer

Telephone

Address

Job Title

Employment Dates (From when to when? Month and year.)

Name of Immediate Supervisor

Description of Duties

Hourly Rate / Salary (Starting)

Hourly Rate / Salary (Final)

Reason for Leaving

May we contact as a reference?

Yes

Add another employer

Yes

Name of Employer

Telephone

Address

Job Title

Employment Dates (From when to when? Month and year.)

Name of Immediate Supervisor

Description of Duties

Hourly Rate / Salary (Starting)

Hourly Rate / Salary (Final)

Reason for Leaving

Add a third employer?

Yes

Name of Employer

Telephone

Address

Job Title

Employment Dates (From when to when? Month and year.)

Name of Immediate Supervisor

Description of Duties

Hourly Rate / Salary (Starting)

Hourly Rate / Salary (Final)

Reason for Leaving

Add a fourth employer

Yes

Name of Employer

Telephone

Address

Job Title

Employment Dates (From when to when? Month and year.)

Course/Seminar

Organization Sponsoring

Content

Date(s) Attended

Required License(s) / Certification(s)

If required to drive a motor vehicle for the job you’re applying for, state your:

Driver’s License Number

State Issued

Expiration Date

Are you licensed/certified with any group, association, or society relating to the job for which you are applying?

Yes

Registrations / Licenses

Registration / License Name

Registration / License Number

State Issued

Expiration Date

Employment References

List at least 3 individuals familiar with your job qualifications (no relatives or personal friends).

Name

Address

Telephone

E-mail Address

Professional Relationship

Years Known

Name

Address

Telephone

E-mail Address

Professional Relationship

Years Known

Name

Address

Telephone

E-mail Address

Professional Relationship

Years Known

Name

Address

Telephone

E-mail Address

Professional Relationship

Years Known

Upload Your Resume

Upload your resume in .pdf, .doc or .docx format

Accepted file types: pdf, doc, docx, Max. file size: 25 MB.

Please Read Carefully Before Signing This Form

1. All information contained in this application is true and correct to the best of my knowledge and belief. I understand that misrepresentations or omissions of any kind may result in denial of employment or subsequent dismissal if I am hired.
2. I authorize the company to investigate my responses on this application and contact any or all of my former employers or any individuals familiar with my employment background for the purpose of verifying any information I have provided and/or for the purpose of obtaining any information about my employment. I voluntarily and knowingly fully release and hold harmless any person or organization that provides information pertaining to me or my employment.
3. I understand that upon receiving a job offer, drug screening, TB tests, and an annual flu vaccination may be required.
4. Regardless of whether or not I become employed by the company, I recognize this application is not and should not be considered a contract of employment. I understand that employment at the company is on an at-will basis and that my employment may be terminated with or without cause, and without notice, at any time, at my option or the company’s, unless specifically provided otherwise in a written employment contract. I further understand that no company employee or representative has the authority to enter into a contract regarding duration or terms and conditions of employment other than an officer or official of the company, and then only by means of a signed, written document.

I accept these terms.

Typing your name below serves as your electronic signature.

Date

MM slash DD slash YYYY