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  Online Application for Part-Time Employment

Applications need to be completely filled out to be considered.
Date: May 25,2013 @ 10:34 AM
Personal Information
Name
  first last middle
Address
  street city state zip
Contact Info
  home phone
(ex:555-555-1234)		 cell phone email (not required)
Employment Desired
Position Desired

start date

salary desired

Are you currently employed?  
If so, may we inquire of your present employer?
Ever applied at this company before?
Where?

When?

Referred By


Which of our locations are you interested in working in?
Hold CTRL key to select more than one location.


Which departments are you interested in?
Are you over 18 years or older?

Have you ever been convicted of a felony? If yes, please state the type of conviction and the circumstances.
If yes, give dates and details:
Answering "yes" to this question does not constitute an automatic rejection for employment. Date of the offense, seriousness and nature of the violation, rehabilitation, and position applied for will be considered.

Are you authorized to work in the United States?

What experiences, skills and capabilities do you posess that would make you a valuable employee?

Are there any hours, shifts or days that you cannot or will not work?

Are you physically capable of standing for five consecutive hours?

Are you physically capable of lifting 40 pounds?
Education
  Name and Address of School # of years Graduate? Subjects Studied
Grammar School name:
addr:
High School name:
addr:
College name:
addr:
Trade, business, or correspondence school name:
addr:
Former Employers (List below last three employers, starting with last one first.)



Dates Name of Employer Position Reason for leaving N/A
from:
to:   
(mm/dd/yyyy)
addr:
city:
state:
salary:
from:
to:   
(mm/dd/yyyy)
addr:
city:
state:
salary:
from:
to:   
(mm/dd/yyyy)
addr:
city:
state:
salary:
References Give the names of 3 people not related to you. Whom you have known at least one year.
Name Address Business Years Acquainted

city:    state: 

city:    state: 

city:    state: 
"I certify that the facts contained in this application are true and complete to the best of my knowledge and understand that, if employed, falsified statements on this application shall be grounds for dismissal.

I authorize investigation of all statements contained herein and the references and employers listed above to give you any and all information concerning my previous employment and any pertinent information they may have, personal or otherwise, and release the company from liability for any damage that may result from utilization of such information.

I also understand and agree that no representative of the company has any authority to enter into any agreement for employment for any specified period of time, or to make any agreement contrary to the foregoing, unless it is in writing and signed by an authorized company representative.

I also understand and agree to allow my application to be transmitted through the internet."

Berkot's Super Foods is an Equal Opportunity Employer. submit