Application of Employment

Bomgaars Application for Employment

* Asterisks indicate a REQUIRED FIELD - PLEASE fill out to proceed.
STATE THE FACTS! Associates may be terminated after hiring for misrepresentation on this application.

WE ARE AN EQUAL OPPORTUNITY EMPLOYER*

Federal law obligates us to provide reasonable accommodation to the known disabilities of applicants and employees, unless to do so would pose an undue hardship. Please feel free to let us know if you need an accommodation to complete the application process or to perform any essential elements of the position sought.

Step 1: Basic Information

NOTE: BACKGROUND CHECKS MAY BE PERFORMED
Full Name: *

First Name Last Name
Today's Date/Time: *

Month Day Year Hour Minutes AM/PM Option
Phone Number: *
E-mail: *
Current Address: *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
How long have you lived at your current address? *
Previous Address: *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
How long have you lived at your previous address? *
Do you OWN or RENT your home?

OWN RENT

Step 3: Previous Work Experience

Give employment record as completely as possible, starting with your present or last employer. Attach an additional sheet if necessary. For any unemployed periods, show dates and location. Exclude organization names or terms which indicate, for example, race, color, religion, sex, national origin, disability, age, etc.
A) Company Name/Address:
A) Date (MO/YR):
A) Rate of Pay:
A) Job Title:
A) Supervisor:
A) Reason for Leaving:
A) Additional Work Experience?

Yes No
Please state the qualifications and/or experience you have, in addition to the above or in its place which would qualify you for the position (s) applied for: *

B) Company Name/Address:
B) Date (MO/YR):
B) Rate of Pay:
B) Job Title:
B) Supervisor:
B) Reason for Leaving:
B) Additional Work Experience?

Yes No

C) Company Name/Address:
C) Date (MO/YR):
C) Rate of Pay:
C) Job Title:
C) Supervisor:
C) Reason for Leaving:
C) Additional Work Experience?

Yes No

D) Company Name/Address:
D) Date (MO/YR):
D) Rate of Pay:
D) Job Title:
D) Supervisor:
D) Reason for Leaving:

Step 4: Education

Please list all education or specialized experience which you feel relates to the position(s) applied for and would help you , such as schools, colleges, military training, accomplishments, experience, etc. Exclude organization names or terms which indicate, for example, race, color, religion, sex, national origin, disability, age. etc.
A) School:
A) School Address:
A) Degrees:
A) Degrees:
A) Special Achievements - Experience
A) Additional Education:

Yes No

B) School:
B) School Address:
B) Degrees:
B) Special Achievements - Experience
B) Additional Education:

Yes No

C) School:
C) School Address:
C) Degrees:
C) Special Achievements - Experience

Step 5: Background
Have you ever served in the Armed Forces: *

Yes No
If yes, what where your duties?
Have you ever been convicted of a felony? *

Yes No
If yes, explain:
An affirmative answer will not automatically disqualify you from being considered for employment. The recency, severity, and pertinence of the conviction to the job will all be considered.
Have you ever been bonded? *

Yes No
Have you ever been refused bonding? *

Yes No
If yes, explain:

Step 6: Misc. Questions
Do you have any friends or relatives working here? *

Yes No
If yes, please name them:
Have you even been employed here before? *

Yes No
Have you ever been involuntarily discharged from employment? *

Yes No
If yes, explain?
___________________
Rate of Pay Expected: *

If hired, you will be required to submit documents sufficient to establish employment authorization and identity in compliance with the Immigration Reform and Control Act of 1986. While you may not provide this proof of citizenship or immigration status at the time you are interviewed, please be prepared to assure us that you can do so immediately upon being hired.

______________

I hereby give Bomgaars the right to make a thorough investigation with past employers of my past performance, schools of my educational records, law enforcement agencies of my potential criminal record and any other agency providing legal pre-employment evaluation information. If you are hired you must successfully pass a drug screen. I release from all liability all persons, companies, and corporations supplying such information. I also indemnify this Employer against any liability which might result from making such investigation. I understand that any false answer or statements or implications made by me in this application or other required documents may result in denial of employment or discipline or discharge if already employed. The above answers are true and complete to the best of my knowledge.

______________

Additionally, I understand that nothing contained in this employment application or in the granting of an interview is intended to create an employment contract between this employer and myself for either employment or for providing of any benefits. No promises regarding employment have been made to me and I understand that no such promise or guarantee is binding upon this employer. I also understand that I have the right to terminate my employment at any time with or without cause and that the employer retains a similar right.
Signature *

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This application is good for 30 days
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Bomgaars Application for Employment