Apply Now — Willow Creek

Personal information

Full Name

First Name

Last Name

Address

Your Current Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone

Best Number

(###)

###

####

Email Address

Position Information/Requests

Position Applying For

Salary of Previous Position

Status Request

Referral Source (If current employee, please indicate employee's name)

Questions

Have you completed an application for employment here before?

Yes

If yes, please indicate when:

Have you been employed by this facility before?

Yes

If yes, please indicate when:

What date are you available for work?

Are you 18 years of age or in possession of a valid work permit?

Yes

Are you legally eligible for employment in the United States? (As a condition of employment you must complete an I-9 form required by the Immigration and Naturalization Service.)

Yes

Are you currently employed?

Yes

If yes, please indicate where:

May we contact your current employer?

If yes, please provide contact information:

education

Name and Location of High School

Graduation

Yes

Name and Location of Other Training

Please indicate the trade

Completion

Yes

Employment History (Begin with the most recent position)

1. Employer's Name and Address

Position Held

Dates Position Held

Starting Rate/Final Pay

Reason For Leaving

2. Employer's Name and Address

Position Held

Dates Position Held

Starting Rate/Final Pay

Reason For Leaving

3. Employer's Name and Address

Position Held

Dates Position Held

Starting Rate/Final Pay

Reason For Leaving

Professional Licenses/Certificates

1. Type

License Number

Date Issued

YYYY

Issued by Organization/State

2. Type

License Number

Date Issued

YYYY

Issued by Organization/State

3. Type

License Number

Date Issued

YYYY

Issued by Organization/State

4. Type

License Number

Date Issued

YYYY

Issued by Organization/State

Professional References

1. Name

Professional Relationship

Supervisor

Colleague

Other

Company Address

Telephone

(###)

###

####

2. Name

Professional Relationship

Supervisor

Colleague

Other

Company Address

Telephone

(###)

###

####

3. Name

Professional Relationship

Supervisor

Colleague

Other

Company Address

Telephone

(###)

###

####

4. Name

Professional Relationship

Supervisor

Colleague

Other

Company Address

Telephone

(###)

###

####

Background Information (A conviction record will not necessarily be a bar to employment)

Have you been convicted of a felony in the past 7 years, excluding misdemeanors and summary offenses, which have not been annulled, expunged, pardoned, statutorily eradicated, dismissed upon condition of probation, or sealed by a court?

A conviction includes a plea of no contest, a plea of guilt or any court determination of guilt. A conviction will not necessarily disqualify you from employment. We will consider the nature, date, and circumstances of each offense as well as whether the offense is relevant to the duties for the position for which you are applying.

Yes

If "Yes," please describe in full detail:

Have you ever been discharged, suspended, or asked to resign from any position?

Yes

If "Yes," please describe in full detail:

Applicant's Certification - Please read carefully before submitting

I hereby certify that all answers on this application are true and correct to the best of my knowledge and belief. I understand that any misrepresentation will be considered just cause for rejection of this application or dismissal from employment. I understand and agree that, if employed, such employment may be terminated at any time, without prior notice, and that my employment will not be governed by any expressed or implied contract, but is at will. We conduct our business with the highest possible degree of safety and efficiency. Because of this, we require all applicants after receiving a conditional offer of employment to undergo urinalysis screening for drug or alcohol use as part of a pre-placement physical examination, and/or drug testing. Successful completion of an employment physical exam, which includes completion of a medical history questionnaire and testing for drugs, is required for employment. I acknowledge that refusing to submit to such screening will cause my application for employment to be rejected. In addition, all employees of the company may be subjected to random urinalysis screening for drug or alcohol use. The company is an equal opportunity employer. We adhere to a policy of making employment decisions without regard to race, color, age, gender, religion, national origin, marital status, veteran status, disability, or any other status protected by federal, state, or local law. We assure you that your opportunity for employment depends solely upon your qualifications. It is the company's policy not to refuse to hire a qualified individual with a disability because of that person's need for a reasonable accommodation as required by the Americans with Disabilities Act. A reasonable accomodation is a change in the way job duties are normally performed that will ensure as equal employment opportunity without imposing undue hardship on the company. Please inform the company's HR Delegate if you need assistance completing any forms or to otherwise participate in application process. "If I test positive for drugs which are not part of a curently prescribed medical treatment program by a licensed physician, I will not be considered for employment." I understand that if I am hired, my employment is for no definite time and may be terminated at any time without prior notice.

Today's Date

YYYY

This company is an equal opportunity employer. All applicants will be considered without discrimination of race, religion, color, sex, age, national origin, marital status, veteran status, medical condition, disability, or any other status protected by federal, state, and local law.

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