Application Employment Application Step 1 of 6 16% PERSONAL INFOFirst Name*Middle Name*Last Name*Current Address* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Prior Address Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Email Primary Phone Number*Alternate Phone NumberAre you eligible to work in the U.S?*YesNoAre you at least 18 years or older?*YesNoCan you work overtime, including weekends?*YesNo POSITIONWhich shift(s) are you available to work? 1st (6:00am-2:30pm) 2nd (2:30pm-11:00pm) 3rd (10:00pm-6:00am) Date you can start* Date Format: MM slash DD slash YYYY Hourly rate desiredPosition desired*Are you currently employed?*YesNoIf so, may we inquire of your present employer?*YesNo How did you hear about us?*Walk InAdvertisementReferralWho referred you?Have you ever worked for this company before?*YesNoIf yes, please provide date(s) and title*Do you know anyone who works for this company?*YesNoIf yes, who?* EDUCATIONHigh SchoolNo. of Years Completed (check one)1234Diploma*YesNoHigh School Equivalent*YesNoHigh School(s)*Please Include City & StateCollege and/or Vocational SchoolNo. of Years Completed (check one)01234College and/or Vocational School(s)Please Include City & StateMajorDegrees EarnedHave you served in the U.S. Armed Forces?*YesNoBranch of Military Service*Period of Military Service (Month & Year)* EMPLOYMENT HISTORYMost Recent EmployerCompany NameCityStateDate Employed From Date Format: MM slash DD slash YYYY Date Employed To Date Format: MM slash DD slash YYYY Job TitleSupervisor NameDutiesSalarySalary PerHourWeekMonthReason for LeavingSecond Most Recent EmployerCompany NameCityStateDate Employed From Date Format: MM slash DD slash YYYY Date Employed To Date Format: MM slash DD slash YYYY Job TitleSupervisor NameDutiesSalarySalary PerHourWeekMonthReason for LeavingThird Most Recent EmployerCompany NameCityStateDate Employed From Date Format: MM slash DD slash YYYY Date Employed To Date Format: MM slash DD slash YYYY Job TitleSupervisor NameDutiesSalarySalary PerHourWeekMonthReason 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*CAPTCHANameThis field is for validation purposes and should be left unchanged.
