Step 1 of 5 20% Position of Interest HiddenDate of Application MM slash DD slash YYYY How did you hear about us?OnlineRadio AdBillboardAn EmployeeSocial MediaOtherName* First Middle Last Email Current Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Phone*Do you have the legal right to work in the U.S.?* Yes No Are you 18 or Older?* Yes No Can you provide proof of age? Yes No (Required for commercial drivers)Who referred you to Plaisted Companies? Expected pay rateexample: 12,345.56 EDUCATIONHighest grade completed* GED* Yes No College or technical degree Certifications/licenses Other applicable skills/training Last school attended*NameCity, State WORK EXPERIENCE AND QUALIFICATIONSAre you currently employed?* Yes No If not, how long since leaving last employment? Are you able and willing to work long hours and some weekends, sometimes with little advanced notice?* Yes No Are early morning start times a problem for you?* Yes No Are irregular hours a problem?* Yes No Will some physical work, such as lifting boxes, be a problem for you?* Yes No Is there any reason you might be unable to perform the essential functions of the job for which you have applied?* Yes No If yes, explain if you choose EMPLOYMENT HISTORYPlease list your last 3 employers, within the past 5 years, start with the last employer first.*Dates Worked (D/M/Y - D/M/Y)Employer NameAddress and Phone NumberContact PersonPositionReason for LeavingSalary/Wage Start with most recent employer. Hit the plus sign to add up to 4 previous employers total. If any employment was under a different name, please indicate. ACKNOWLEDGEMENTPlease read the following before clicking "I agree" below.I certify all information contained in this application is true and correct to the best of my knowledge and belief. I understand that misrepresentations or omissions of any kind may result in denial of employment or be cause for subsequent dismissal if I am hired. I authorize the company to investigate my responses on this application and contact any or all of my former employers or any individuals familiar with my employment background for the purpose of verifying any information I have provided and/or for the purpose of obtaining any information about my employment. I voluntarily and knowingly fully release and hold harmless any person or organization that provides information pertaining to me or my employment. I understand that upon receiving a job offer, a physical examination and drug screening may be required. (Note: If this is a job requirement, you will be notified.) Regardless of whether or not I become employed by the company, I recognize this application is not and should not be considered a contract of employment. I understand that employment at the company is on an at-will basis and that my employment may be terminated with or without cause, and without notice, at any time, at my option or the company’s, unless specifically provided otherwise in a written employment contract. I further understand that no company employee or representative has the authority to enter into a contract regarding duration or terms and conditions of employment other than an officer or official of the company, and then only by means of a signed, written document.Digital Signature* I agree to the above and certify that all the information I have provided is correct.Today's Date MM slash DD slash YYYY
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