Indian Springs Employment Application


We consider applicants for all positions without regard to race, color, religion, sex, national origin, age, marital or veteran status, sexual orientation, disability, or any other protected classification.

The field descriptions in DARK text are required.
Desired Schedule: Fulltime    Parttime   Either

Personal Information
First Name: Middle Name: Last Name:
Address:
City: State: Zip:
How Long Have You Lived There? Yrs.    Mos.
Previous Address:
City: State: Zip:
How Long Have You Lived There? Yrs.    Mos.
Home Phone: Social Security Number:
E-mail:
Are you legally authorized to work in the U.S.?:
(If hired, you will be required to provide proof of work authorization.) 		Yes No
If you are under the age of 18, can you provide required proof of your eligibility to work?: Yes No
Have you ever filed an Application Form with us before?: Yes No
Have you ever been employed with us before?: Yes No
Do we currently employee a member of your family or household?: Yes No
Are you currently employed?: Yes No
When would you be available to start?: Date Format (mm/dd/yyyy)
Are you currently on "lay-off" status and subject to recall?: Yes No
Can you travel if a job requires it?: Yes No
Have you ever been convicted of a criminal offense (other than minor traffic violations), or are you awaiting trial for a criminal offense?:
(Answering “yes” will not necessarily disqualify an applicant from employment.) 		Yes No
Criminal Offense includes felonies, misdemeanors, summary offenses and convictions resulting from a plea of “nolo contendere” (no contest.)
Conviction is an adjudication of guilt and includes determinations before a court, a district justice or a magistrate which results in a fine, sentence or probation.
If yes, please explain:
What times are you available to work?: (fill in times on days that apply)  
Mon.    Tues.    Wed.
Thurs.    Fri. Sat.    Sun.   
Indicate any foreign languages you can speak, read and/or write:
Fluent Good Fair
Speak -

Read -

Write -


Education
Name & Location of School Select Last Year Completed Major Course Diploma/Degree
High School
College/University
Business/Trade School or Other


Employment History
List employment starting with your most recent position list all employment for the last 10 years and explain all gaps in your employment. Include any job-related service assignments, and volunteer activities. You may exclude volunteer organizations which indicate race, color, religion, gender, national origin, handicap or other protected status.
Employer: Address/City:
From (MM/YYYY): To (MM/YYYY):
Your Job Title:
Supervisor: Phone:
Wages (starting): Wages (ending):
Type of Work:
Reason for Leaving:
Employer: Address/City:
From (MM/YYYY): To (MM/YYYY):
Your Job Title:
Supervisor: Phone:
Wages (starting): Wages (ending):
Type of Work:
Reason for Leaving:
Employer: Address/City:
From (MM/YYYY): To (MM/YYYY):
Your Job Title:
Supervisor: Phone:
Wages (starting): Wages (ending):
Type of Work:
Reason for Leaving:
Special Skills and Qualifications
Summarize special job-related skills and qualifications acquired from employment or other experience.


Employment References
Give name, address, including City, State and Zip code and telephone number of two references who are not related to you and are not previous employers.
1) Name of Reference: 2) Name of Reference:
Occupation: Occupation:
Address: Address:
City/State/Zip: City/State/Zip:
Phone: Phone:
Relationship: Relationship:
How long known: How long known:


Certification and Agreement
READ CAREFULLY BEFORE SUBMITTING APPLICATION FORM

1. Any misrepresentation or omission of facts in my application form or any attachments to my application form (including any resumes) may result in refusal of employment or if employed, termination from employment.

2. I understand and agree that any person authorized by the Company can at any time request that I submit to a search of my person, purses, packages in my possession, or any locker, desk or files that may be assigned to me. I understand that my refusal to submit to such a search may result in termination. I hereby waive all claims for damages resulting from such examination.

3. I understand and agree that I may be required to take a physical examination, blood, urine, or hair test at Company expense, at any time to determine if I am alcohol or drug free and physically fit for the job I am responsible to perform. Failure to submit to such testing may result in termination. I authorize any physician, including my personal physician, to release any information to the Company which may be necessary to determine my ability to perform my assigned duties.

4. I further understand that the Company can change wages, benefits and/or working conditions at any time and that I may be required to work overtime or on weekends, depending upon job requirements.

5. I UNDERSTAND THAT THE COMPANY MAY, FROM TIME TO TIME, ESTABLISH RULES, REGULATIONS, POLICIES AND/OR DISCIPLINARY PROCEDURES, SOME OF WHICH MAY BE REDUCED TO WRITING. IN CONSIDERATION OF MY EMPLOYMENT, I AGREE TO CONFORM TO ALL APPLICABLE RULES, REGULATIONS, POLICIES, AND/OR DISCIPLINARY PROCEDURES OF THE COMPANY AND/OR ANY DEPARTMENT THEREOF. I UNDERSTAND THAT THOSE RULES, REGULATIONS, POLICIES AND/OR DISCIPLINARY PROCEDURES ARE NOT INTENDED BY THE COMPANY TO CREATE AN OBLIGATION OR EXPECTATION OF CONTINUED EMPLOYMENT.

6. I UNDERSTAND THAT THIS DOCUMENT IS AN application form FOR EMPLOYMENT AND CONTINUED EMPLOYMENT IS NOT BEING OFFERED. I UNDERSTAND AND AGREE THAT MY EMPLOYMENT, BOTH DURING AND AFTER ANY INTRODUCTORY OR ORIENTATION PERIOD, IS FOR AN INDEFINITE PERIOD, AND THAT NOTHING IN THIS APPLICATION FORM OR ANY OTHER COMPANY DOCUMENT SHALL BE DEEMED TO CREATE ANY CONTRACT OF CONTINUED EMPLOYMENT BETWEEN ME AND THE COMPANY. I FURTHER UNDERSTAND THAT MY EMPLOYMENT CAN BE TERMINATED AT WILL AT ANY TIME BY MYSELF OR THE COMPANY FOR ANY OR NO CAUSE. I UNDERSTAND THAT EMPLOYMENT BEYOND ANY INTRODUCTORY OR ORIENTATION PERIOD OR EMPLOYMENT FOR A NUMBER OF YEARS SHALL NOT RESULT IN ANY HEIGHTENED EXPECTATION OF CONTINUED EMPLOYMENT. I UNDERSTAND AND AGREE THAT ANY STATEMENTS TO THE CONTRARY, WHETHER ORAL OR WRITTEN, ARE EXPRESSLY DISAVOWED AND ARE NOT TO BE RELIED UPON BY ME. I FURTHER UNDERSTAND THAT NO REPRESENTATIVE OF THE COMPANY HAS ANY AUTHORITY TO ENTER INTO AN AGREEMENT FOR EMPLOYMENT FOR ANY SPECIFIED PERIOD OF TIME OR TO MAKE ANY AGREEMENT CONTRARY TO THE FOREGOING EXCEPT IN A WRITTEN DOCUMENT SIGNED BY THE PRESIDENT OF THE COMPANY.

7. It is my understanding that this application form for employment will only remain active for thirty (30) days following the date of application form.

Check this box to certify that you have read and accept the above statement.

(Please allow 10-15 seconds for processing. Do not click the submission button more than once.)