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Eagle River, Alaska
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Employment Application

Employment Application

This Application will be considered active for 60 days from the day you complete and submit it. If you wish to be considered for employment after that time, you must submit a new Application. You must complete this Application in its entirety and on your own.



First Name Last Name Middle Name SSN
Telephone Mobile Phone Email


Street Address City State Zip Phone Lenght of time at address
Current
Previous
Previous
Previous
In Case of Emergency, Notify:     Phone:

Address:

Referral Source I am Seeking To Work I am Available To Work *













Hours:
Hours:
Hours:
Hours:
Hours:
Hours:
Hours:
* The Company endeavors to accommodate all bona fide religious restrictions.

Position Sought Rate of Pay Expected I am available to Start Employment On:

References: Please list three business, professional, or other persons who can attest to your work capabilities (do not include relatives or former employers). **
Name Address Phone Occupation
** Please exclude any activities or organizations which indirectly or directly disclose race, color, religion, sex, national origin or any other protected classification.


Questions/Qualifications Yes/No
Are you over eighteen years of age? (If not, employment is subject to verification that you are of minimum legal age and that you are able to supply any required work permit.)
Have you previously applied for employment here? If yes, give date:
Have you previously been employed here? If yes, give date:
Are you either a citizen of the United States or an alien authorized to work in the United States? (Employment is, of course, subject to verification of authorization to work in the United States.)
Are you on layoff and subject to recall?
May we contact the employers (including your current employer) listed in this Application?
Have you ever been disciplined or discharged from employment?
Have you ever been asked to resign from employment?
Are you related to anyone who currently works or previously worked for the Company, or any related Company?
Do you currently use illegal drugs?
Have you ever been convicted of a felony crime, or a crime involving dishonesty or lack of truthfulness (SIS, probation, guilty plea, nolo contendere, etc. are all convictions)***
Have you ever served in the military?
Are you able to perform the essential functions of the job for which you are applying, either with or without a reasonable accommodation?
Are you able to satisfy the attendance requirements of the job?
*** A conviction will not necessarily be a bar to employment; factors such as age at time of the offense, seriousness and nature of the violation and rehabilitation will be taken into account. You are not obligated to disclose sealed or expunged records or convictions.

Education Elementary/ Middle School High School College/ University Graduate Professional Trade, Business Or Other
School Name
City and State
Years Completed
Diploma/Degree
Describe Course of Study
Identify Specialized Training, Apprenticeship, Skills and Extra-Curricular Activities
Honors Received

Employment Experience: Start with your present or last job, including self-employment, and work back. Be certain to list all jobs you have held and be certain to account for all periods of unemployment. Include military service assignments and volunteer activities. If more space is needed, attach and sign a separate page.
Employer Job Title(s) Dates Employed Work Perfomed
From To
 
Address Supervisor(s)
Hourly Rate/Salary
Starting Final
Phone Reason(s) For Leaving

Employer Job Title(s) Dates Employed Work Perfomed
From To
 
Address Supervisor(s)
Hourly Rate/Salary
Starting Final
Phone Reason(s) For Leaving

Employer Job Title(s) Dates Employed Work Perfomed
From To
 
Address Supervisor(s)
Hourly Rate/Salary
Starting Final
Phone Reason(s) For Leaving

Employer Job Title(s) Dates Employed Work Perfomed
From To
 
Address Supervisor(s)
Hourly Rate/Salary
Starting Final
Phone Reason(s) For Leaving


AUTHORIZATION: READ CAREFULLY

I hereby certify that my answers above are true, correct and complete and I further understand that any information provided by me that is found to be false, incomplete or misrepresented in any respect, will be sufficient cause to (1) cancel further consideration of this application, or (2) immediately discharge me from the employer's service, whenever it is discovered.

I believe that information concerning my performance as an employee, as well as information concerning my personal habits, conduct, deportment, as well as the information outlined hereinabove will assist me in obtaining employment with the Company. Therefore, in consideration for the Company’s act of considering me for employment, I hereby agree to release and hold harmless the Company, together with its officers, agents, employees, affiliated corporations, subsidiaries, successors and assigns, from any and all liability in any way related to the investigation of my suitability for employment with the Company, including, but not limited to, any liability relating to contact and/or discussions with any of my employers, references, relatives, and/or acquaintances (past and/or present). Moreover, I specifically authorize any person (natural or otherwise) to make full response to any inquiry in connection with my Application for Employment with the Company, and I release any such person from all liability arising therefrom. I authorize the Company to obtain an investigative consumer report and/or a report from any law enforcement agency which may include both general and personal information about me at any time either prior to or during your employment.

In the event that I am employed, I understand that regardless of the shift and job that I am first assigned, I may be required to accept a change of job or shift depending on my demonstrated skills after employment and the needs of the Company. I consent to take any physical or medical examinations, including blood and urine or other tests for alcohol and drugs, requested by the Company in connection with the processing of my application for employment and further agree to take any such physical or medical examinations requested by the Company during my employment if I am offered and accept a job when such examinations are job-related and consistent with business necessity. I understand that such an examination may be needed in order to determine my competence to perform the job or work for which I was hired, or to identify any physical or mental condition bearing on my job performance. I understand that refusal to submit to any physical or medical examination ordered by the Company will result in rejection for employment or for disciplinary action up to and including immediate discharge. I further understand that any information obtained through such exams may be retained by the Company and is exclusively the Company's property. I also understand that the examinations will be performed by medical personnel, clinics or laboratories qualified to do the necessary work and costs for such examinations will be borne by the Company.

I understand that, in the event I am employed by the Company: my employment will not be for any specific period, length, or term of employment; my employment and compensation can be terminated by me or the Company at any time, with or without notice, except as may be required by law, and with or without cause and for any reason or no reason; and that no present or future employee handbook, policy manual or publication constitutes an employment agreement or contract. I further understand that no employee of the Company other than the Company’s President, has the authority to commit to anyone employment for any definite or estimated period of time or otherwise to enter into an employment contract and that any such agreement is invalid unless in writing and signed by both me and the Company President. I further certify that no representations contrary to the foregoing have been made to me by anyone; I agree to notify the Company President, in writing, within 48 hours of communication of any such representation.

I also understand that if I am hired, I will be required to provide proof of identity and legal authority to work in the United States and that federal immigration laws require me to complete an I-9 Form in this regard.