APPLICATION FOR EMPLOYMENT Personal Information Name (Full - Last, First, MI) * What date are you available to start work? Street Address Address City/Town State/Province - None -AlabamaAlaskaAmerican SamoaArizonaArkansasArmed Forces (Canada, Europe, Africa, or Middle East)Armed Forces AmericasArmed Forces PacificCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFederated States of MicronesiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarshall IslandsMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPalauPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirgin IslandsVirginiaWashingtonWest VirginiaWisconsinWyoming ZIP/Postal Code Phone Email Have you ever filed an application with us before? If so, give a date. Have you previously been employed by S&H? If so, when? Do you have any friends or relatives working here? If so, please list their name(s) Are you legally authorized to work in the United States? Can you provide proof of eligibility to work in the US? Are you at least 18 years of age? Can you furnish a work permit? (Applicable if under age 16) Position applied for: Desired Wages/Salary Are you willing to work Full Time, Part Time, Temporary, 2nd Shift, Weekends, and/or Overtime? List all that apply. Education High School City/State Did you graduate or obtain a GED? College City/State Did you obtain a degree? Degree Recieved Or Expected How many years of attendance? College 2 City/State Did you obtain a degree? Degree Recieved Or Expected How many years of attendance? Other job-related, educational institutions, licenses, certifications, any specialized training, apprenticeship, skills or any additional information you feel may be helpful to us in considering your application. Employment History (List below last employers, starting with the most recent one first)Employment Position 1 Present or Last Position Name of Company Employment Period (Start Mo/Yr to End Mo/Yr) Address, City, State, and ZIP of Business Duties: Reason for Leaving: Name of Supervisor Title and Department of Supervisor Phone Number of Supervisor May we contact your supervisor? Employment Position 2 Next Previous Position Name of Company Employment Period (Start Mo/Yr to End Mo/Yr) Address, City, State, and ZIP of Business Duties: Reason for Leaving: Name of Supervisor Title and Department of Supervisor Phone Number of Supervisor May we contact your supervisor? Employment Position 3 Next Previous Position Name of Company Employment Period (Start Mo/Yr to End Mo/Yr) Address, City, State, and ZIP of Business Duties: Reason for Leaving: Name of Supervisor3 Title and Department of Supervisor Phone Number of Supervisor3 May we contact your supervisor? References (List at least 3 responsible adults who have knowledge of your work ethic, experience, and ability.) Reference 1 Name Telephone No. Relationship Reference 2 Name Telephone No. Relationship Reference 3 Name Telephone No. Relationship Are you currently on lay-off and subject to recall? Are you bound by any non-compete agreements with your current or former employer? If so, please explain. Have you ever been convicted of a felony? If so, please explain below giving date, charge, county, & all other detail matter pending and current status: Do you have any comitments or other agreements with another employer that might affect your employment with S&H? I so, please explain? If so, please explain. If applying for a position that requires driving, do you have a valid driver's license? Do you have points on your license? How many? Please list date and description of all chargeable accidents: Have you worked in a position that required a CDL in the past year? Submission Date Signature Sign above Leave this field blank
