"*" indicates required fieldsStep 1 of 616%Answer each question fully and accurately. In reading and answering the following questions, be aware that none of the questions are intended to imply illegal preferences or discrimination based upon non-job-related information.Applying For:Leave blank if you are not applying for a specific position.Are you seeking:* Full-Time Part-Time TemporaryPreferred Start Date* MM slash DD slash YYYY Personal InformationName* First Last Address* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Phone*Email* Enter Email Confirm Email If hired, can you furnish proof you are eligible to work in the U.S.?* Yes NoWere you ever employed here?* Yes NoLast Date Of Employment MM slash DD slash YYYY EducationDid you graduate from high school or receive a GED Certificate?* Yes NoDid you attend college?* Yes NoCollege NameLocationDid you graduate college? Yes NoField of Study*Special SkillsWhat skills or additional training do you have that are related to the job for which you are applying?*What machines or equipment can you operate that are related to the job for which you are applying?For Driving Jobs Only: Do you have a valid driver’s license? Yes NoDriver’s License NumberState of LicenseClass of LicenseList professional, trade, business, or civic activities and offices held.Exclude labor organizations and memberships which reveal race, color, religion, national origin, sex, age, disability or other protected status.Work HistoryList names of employers in consecutive order with present or last employer listed first. Account for all periods of time, including military service and any periods of unemployment. If self-employed, give firm name and supply business references. PLEASE GIVE MONTH AND YEAR.Name of Current/Most Recent EmployerEmployer Address Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Employer PhoneTitleReason for leaving?SupervisorEmployed From: MM slash DD slash YYYY To: MM slash DD slash YYYY Starting PayEnding PayDutiesEmployer 2Name of EmployerEmployer Address Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Employer PhoneTitleReason for leaving?SupervisorEmployed From: MM slash DD slash YYYY To: MM slash DD slash YYYY Starting PayEnding PayDutiesHow Were You Referred*EmployeeSocial MediaDigital AdvertisingPS Industries BillboardRestroom AdvertisingJob ServiceIndeedOtherOther Referral*Employee Referral Name*ResumeAccepted file types: pdf, doc, docx, txt, Max. file size: 48 MB.If you have a resume and would like to include it with your application, please upload it below.AffidavitPLEASE READ EACH STATEMENT CAREFULLY BEFORE SIGNINGI certify that all information provided in this employment application is true and complete. I understand that any false information or omission may disqualify me from further consideration for employment and may result in my dismissal if discovered at a later date.I understand that the employer may request an investigative consumer report from a consumer reporting agency. This report may include information as to my character, reputation, personal characteristics, and mode of living obtained from interviews with neighbors, friends, former employers, schools, and others. I understand I have a right to make a written request within a reasonable time for the disclosure of the name and address of the consumer reporting agency so that I may obtain a complete disclosure of the nature and scope of the investigation.I authorize the investigation of any or all statements contained in this application. I also authorize, whether listed or not, any person, school, current employer, past employers, and organizations to provide relevant information and opinions that may be useful in making a hiring decision. I release such persons and organizations from any legal liability in making such statements. I also authorize the Company to provide truthful information concerning my employment with it to my future prospective employers and I agree to hold it harmless for providing such information.I understand that if I am extended an offer of employment it may be conditioned upon my successfully passing a complete preemployment physical examination. I consent to the release of any or all medical information as may be deemed necessary to judge my capability to do the work for which I am applying.I understand I may be required to successfully pass a drug screening examination. I hereby consent to a pre- and/or post-employment drug screen as a condition of employment, if required. I understand that the company reserves the right to require me to submit to a drug test at any time and also reserves the right to require me to submit to an alcohol test and/or medical examination to the extent permitted by law. I authorize the Company to investigate my driving record, my credit history, and my criminal record.I UNDERSTAND THAT THIS APPLICATION OR SUBSEQUENT EMPLOYMENT DOES NOT CREATE A CONTRACT OF EMPLOYMENT, NOR GUARANTEE EMPLOYMENT FOR ANY DEFINITE PERIOD OF TIME. IF EMPLOYED, I UNDERSTAND THAT I HAVE BEEN HIRED AT THE WILL OF THE EMPLOYER. I FURTHER UNDERSTAND THAT I HAVE THE RIGHT TO TERMINATE MY EMPLOYMENT AT ANY TIME WITH OR WITHOUT NOTICE, AND THE COMPANY HAS THE SAME RIGHT. NO ONE OTHER THAN THE PRESIDENT OF THE COMPANY HAS THE AUTHORITY TO MODIFY THIS RELATIONSHIP OR MAKE ANY AGREEMENT TO THE CONTRARY. ANY SUCH MODIFICATION OR AGREEMENT MUST BE IN WRITING.Signature* Todays Date* MM slash DD slash YYYY CommentsThis field is for validation purposes and should be left unchanged.
