INSTRUCTIONS FOR COMPLETING APPLICATION

  1. Please fill out the entire application electronically.
  2. In order to fill out, you must place the cursor in the area provided. The line will automatically lengthen as your type in your answer. Use the tab key to go to the next question.
  3. Where options are given to answer yes or no questions, click the appropriate button.
  4. The last sheet of the application addresses background checks. Please type in your name and, to confirm your signature, click in the radio button provided (next to the signature).
  5. Your employment history is very important to us. You must give detailed explanations to all questions, in particular Duties and Reasons for Leaving.
  6. Please save a copy of this application for your records.

HIRING POLICIES

Entering a Check this box acknowledges that you signed this document and understand all of the policies and procedures that are stated above as part of our hiring process.


Please fill in all fields marked with an *
 

APPLICATION FOR EMPLOYMENT

(An Equal Opportunity Employer)
Please note: This application form was designed for use by applicants for various positions including field, clerical, professional, technical, and administrative. Please answer the questions to the best of your ability.

Date

 
  Full Name *  Date of Birth
  Social Security Number    Driver's License State and No.
  Home Address
  City   State   Zip  
  Number of years at this address: (year/month)
  Are you 18 years of age or older? Yes No
  Have you applied here before? Yes No*  How Long have you worked here before?
  US Citizen? Yes No*
  Home Phone * Work Phone
  Fax Number Cell Phone
    Person to notify in case of emergency - Name Phone Number  
 

How were you referred to us? Click below for all that apply.
Newspaper School On my own Current Employee Internet Ad Other
Name of referral source

  Position applying for *
Do you wish to work Full Time Part Time     Temporarily  

If part time, what hours or days?   What are your hourly/weekly salary requirements? *
  Date available for work  

 

STEP 2

Do you have commitments to another employer that might effect your employment with us? Yes No
 

Do you know of any reason why you cannot perform the essential functions of the job for which you are applying with or without reasonable accommodations? Yes No

  
 

Please describe any accommodations required.
  Have you ever been convicted of a criminal offense? Yes No
 

Date: Location

Nature:


(An affirmative answer will not automatically disqualify you from being considered as a candidate for employment.)

 


Please list all of the business/work skills you possess:
 


Which, if any, warehouse or construction equipment have you operated?

 

STEP 3

EDUCATION

Are you presently a student ? Yes No Part Time Full Time

 
  Typing Speed if known: (wpm)
 

Name and address of high school(s) attended.

 

Did You Graduate from college? Yes No
Degree From to (Month / year)

 
  Name and address of college(s) attended
 


Other professional licenses, certifications, registrations?
License No / Cert:   Year Issued Location:

  License No / Cert:   Year Issued Location:
 
MILITARY
  
  Were you in the Armed Forces? Yes No If Yes, what branch  
  Date of Duty: From  To:
  Rank at Separation?
  Briefly describe your duties:


 

STEP 4

WORK EXPERIENCE

For employers prior to the follow three, please attach resume.
 

Most Recent/Present Employer Name:

 
  Address
  Job Title
  Base Salary  Per Ex: hour, month year
  Supervisor
  Supervisor Phone Number
  Month/Year Dates Employed. From to (Month/year)
  Reason for leaving
 
 
  Employer #2 Name:  
  Address
  Job Title
  Base Salary  Per Ex: hour, month year.
  Supervisor
  Supervisor Phone Number
  Month/Year Dates Employed. From  To
  Reason for leaving
 
 
  Employer #3 Name:  
  Address
  Job Title
  Base Salary  Per  Ex: hour, month year.
  Supervisor
  Supervisor Phone Number
  Month/Year Dates Employed From: To:
  Reason for leaving
 
 
 

Most Recent Previous Home Address

 
  Home Address
  City  State:  Zip:
  Number of years/months at this residence: Year  / Month
 
 
  REFERENCES

Please list at least three business contacts, such as vendors, subcontractors, contractors and customers.






APPLICANT STATEMENT

Entering a Check in this box acknowledges that you signed this document and understand and agree with the above statements.



DISCLOSURE REGARDING CONSUMER REPORTS

Entering a Check this box acknowledges that you signed this document and understand and agree with the above disclosure regarding consumer reports.



INVESTIGATIVE CONSUMER REPORTS DISCLOSURE

Entering a Check this box acknowledges that you signed this document and understand and agree with the above disclosure regarding investigative consumer reports.



AUTHORIZATION TO OBTAIN CONSUMER REPORTS

Entering a Check this box acknowledges that you signed this document and understand and agree with the above terms and conditions authorizing MCC to obtain consumer reports.

  


 

Copyright ? 2003 MCC GROUP, LLC. All rights reserved.
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