Position Applying For (required) Date of Application Start Date Last Name(required) First Name(required) Middle Initial Present Address(required) City(required) State(required) Zip(required) Permanent Address City(required) State(required) Zip(required) Home Phone Cell Phone Email(required) Are you 18 year or older? YesNo Are there any hours or days of the week you cannot work? YesNo If so, when Salary Desired Type of Employment: Full TimePart Time Are you employed now? YesNo May we contact present employer? YesNo Name, Title, & Phone of current employer: Have you ever applied to this company before? YesNo Where? Under what name When? Education High School Name & Location # of year attended Did you Graduate YesNo Subject/Major College Name & Location # of year attended Did you Graduate YesNo Subject/Major Specialized Training Name & Location # of year attended Did you Graduate YesNo Subject/Major Do you have military experience? YesNo Date Entered Branch Rank Date Discharged Honorably? Are you lawfully entitled to be employed in the United States? YesNo Please provide any additional information such as special skills, training, management experience, equipment operation or qualifications you feel will be helpful to us in considering your application. References Name Address Phone Relationship Years Acquainted Name Address Phone Relationship Years Acquainted Name Address Phone Relationship Years Acquainted Emergency Contact Address State Zip Phone Current & Former Employers (most recent first) Name Street City State Zip Phone Start Salary End Salary Last Position Held/ Responsibilities Reason for Leaving Start Date End Date Name Street City State Zip Phone Start Salary End Salary Last Position Held/ Responsibilities Reason for Leaving Start Date End Date Name Street City State Zip Phone Start Salary End Salary Last Position Held/ Responsibilities Reason for Leaving Start Date End Date Name Street City State Zip Phone Start Salary End Salary Last Position Held/ Responsibilities Reason for Leaving Start Date End Date Name Street City State Zip Phone Start Salary End Salary Last Position Held/ Responsibilities Reason for Leaving Start Date End Date May we contact employers used? YesNo If not, which ones? Please read the following statement carefully before signing to indicate your understanding. I understand that, prior to being offered employment, I may be requested to take an employment examination. In the event that I have a disability that will affect my ability to take the test, I will so inform the Company prior to the test so that a reasonable accommodation can be made. The Company reserves the right to require medical documentation regarding the need for accommodation. I certify that the facts contained in this application are true, accurate, and complete to the best of my knowledge and understand that, if employed, falsified statements or omitted material facts on this application may result in my disqualification from consideration for employment, or termination from employment if I have been hired. I understand and agree that, if hired, my employment is for no definite period and may, regardless of the date of payment of my wages and salary, be terminated with or without cause, at any time, with or without notice. This provision supersedes any oral or written representation to the contrary unless in writing and signed by both the President of the company and the person to whom the writing is directed. I understand that in compliance with federal law, all persons hired will be required to verify identity and eligibility to work in the United States and to complete the required employment eligibility verification document form upon hire. I agree not to commence any action or suit relating to the employment relationship or the hiring process more than 180 calendar days after the lesser of: (i) the date of the event giving rise to the action or suit, or (ii) the applicable statute of limitations. I waive any statute of limitations to the contrary. I authorize investigation of all statements contained in this application for any employment-related purpose. I release the listed references and all employers, except those specifically excepted,* to provide you with any and all applicable information they may have. I release these references and former employers from all liability for any information they may give to the Company and waive any right that I might have to be provided with notice that they are releasing this information, specifically any notice rights under the Bullard-Plawecki Employee Right-to-Know Act. By typing my name below I certify that I have read and understand the above. Full Name Date * Employers specifically excepted: "People are our greatest asset. We have a servant mentality. We put our employees and our customers first. That makes Global Concepts successful." Pete Quality Manager