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360 M E Frick Drive
Washington, MO 63090
1.800.241.2209
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Employment Application
Step
1
of
6
16%
PERSONAL INFO
First Name
*
Middle Name
*
Last Name
*
Current Address
Street Address
*
City
*
State
*
Zip
*
Prior Address
Street Address
City
State
Zip
Email
Primary Phone Number
*
Alternate Phone Number
Are you eligible to work in the U.S?
*
Yes
No
Are you at least 18 years or older?
*
Yes
No
Can you work overtime, including weekends?
*
Yes
No
POSITION
Which shift(s) are you available to work?
1st (6:00am-2:30pm)
2nd (2:30pm-11:30pm)
3rd (10:00pm-6:00am)
Date you can start
*
MM slash DD slash YYYY
Hourly rate desired
Position desired
*
Are you currently employed?
*
Yes
No
If so, may we inquire of your present employer?
*
Yes
No
How did you hear about us?
*
Facebook / Social Media
Referral
Job Search Website
Local Event and/or Signage
TV Streaming Ad
Radio/Music Streaming
Who referred you?
Have you ever worked for this company before?
*
Yes
No
If yes, please provide date(s) and title
*
Do you know anyone who works for this company?
*
Yes
No
If yes, who?
*
EDUCATION
High School
No. of Years Completed (check one)
1
2
3
4
Diploma
*
Yes
No
High School Equivalent
*
Yes
No
High School(s)
*
Please Include City & State
College and/or Vocational School
No. of Years Completed (check one)
0
1
2
3
4
College and/or Vocational School(s)
Please Include City & State
Major
Degrees Earned
Have you served in the U.S. Armed Forces?
*
Yes
No
Branch of Military Service
*
Period of Military Service (Month & Year)
*
EMPLOYMENT HISTORY
Most Recent Employer
Company Name
City
State
Date Employed From (mm/dd/yyyy)
MM slash DD slash YYYY
Date Employed To (mm/dd/yyyy)
MM slash DD slash YYYY
Job Title
Supervisor Name
Duties
Salary (do not include "$")
Salary Per
Hour
Week
Month
Reason for Leaving
Second Most Recent Employer
Company Name
City
State
Date Employed From (mm/dd/yyyy)
MM slash DD slash YYYY
Date Employed To (mm/dd/yyyy)
MM slash DD slash YYYY
Job Title
Supervisor Name
Duties
Salary
Salary Per
Hour
Week
Month
Reason for Leaving
Third Most Recent Employer
Company Name
City
State
Date Employed From (mm/dd/yyyy)
MM slash DD slash YYYY
Date Employed To (mm/dd/yyyy)
MM slash DD slash YYYY
Job Title
Supervisor Name
Duties
Salary
Salary Per
Hour
Week
Month
Reason for Leaving
CERTIFICATION AND RELEASE
I hereby certify that the facts set forth in the above employment application are true and complete to the best of my knowledge and authorize Frick’s to verify their accuracy and to obtain reference information on my work performance. I hereby release Frick’s from any/all liability of whatever kind and nature which, at any time, could result from obtaining and having an employment decision based on such information.
I understand that, if employed, falsified statements of any kind or omissions of facts called for on this application shall be considered sufficient basis for dismissal.
I understand that should an employment offer be extended to me and accepted that I will fully adhere to the policies, rules and regulations of employment of the Employer. I further understand that neither the policies, rules, regulations of employment nor anything said during the interview process shall be deemed to constitute the terms of an implied employment contract. Acceptance of an offer of employment does not create a contractual obligation upon the Employer to continue employment or to employ me in the future.
All applicants are required to submit to a Urinalysis to be considered for employment. A positive drug test will result in the ineligibility to be hired. Proof of prescription medication may be required.
If the Employer decides to engage an investigative consumer reporting agency to report on my credit and personal history, I hereby grant authorization to do so. If a report is obtained the Employer must provide, at my request, the name and address of the agency so I may obtain from them the nature and substance of the information contained in the report.
Signature
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