Personal Information Position First Name * Middle Name Last Name * Address * City * State * Zip/Postal Code * Mailing Address (If Different From Above) Mailing City Mailing State Mailing Zip/Postal Code Country * Telephone * Email * Minimum salary requirements * Dates available for work * Days and hours available * Preference Full-TimePart-Time Are you 18 years of age or older? YesNo If hired, can you present evidence of your US Citizenship or proof of legal right to live and work in this country? YesNo Have you ever filed an application or have been employed here before? YesNo Do you have any friends or relatives working for our company? YesNo Relationship? *If answer "Yes" to either of these questions, please give details of the circumstances: BEFORE answering the following question, please read the Instructions below. PLEASE READ: LOS ANGELES AND SAN FRANCISCO APPLICANTS: DO NOT ANSWER THE QUESTION BELOW AT THIS TIME. YOU WILL ONLY HAVE TO ANSWER THIS QUESTION AFTER A CONDITIONAL OFFER OF EMPLOYMENT. Please note that you do NOT have to identify (a) arrests that did not result in a conviction or (b) a record of any adult or juvenile arrest, detention or conviction that has been sealed, expunged, annulled, erased, pardoned, shielded or statutorily eradicated, set aside or otherwise dismissed by court order. Please note that answering “Yes” to this question will not automatically bar you from employment. Have you ever been convicted of or pleaded guilty or no contest to any crime? (Note that you only should answer “yes” if you have a conviction that is not listed below in the Instructions.) YesNo If "Yes", please include the type of offense, the approximate date and disposition of the case: No applicant will be denied employment solely on the grounds of a conviction of a criminal offense. The nature, circumstances and the relevance of the offense to the position(s) applied for may, however, be considered. California Applicants: Do not identify any misdemeanor conviction for which probation has been successfully completed or otherwise discharged and the case has been dismissed by a court. Also do not identify any arrest, adjudication or conviction that occurred while you were subject to the process and jurisdiction of a juvenile court. Also, do not identify the following marijuana-related convictions entered by the court more than 2 years ago: an infraction or a misdemeanor for unlawful possession of marijuana or a misdemeanor conviction for (a) transportation or giving away of up to 28.5 grams of marijuana, other than concentrated cannabis, or the offering to transport or give away up to 28.5 grams of marijuana, other than concentrated cannabis; (b) possession of paraphernalia used to smoke marijuana; (c) being in a place with knowledge that marijuana was being used; or (d) being under the influence of marijuana. Also, do not identify any arrest or detention that did not result in a conviction or any record of a referral to, and participation in, any pretrial or post-trial diversion program, and do not identify any pending charges for which entry into a diversion program has taken place and final disposition is pending. Los Angeles and San Francisco Applicants: Do not respond to the above question. Are you able to perform the essential functions of the job for which you are applying, either with or without reasonable accommodation? YesNo (Note: We comply with the ADA and consider reasonable accommodation measures that may be necessary for eligible applicants/employees to perform essential functions. May be subject to medical exam, skill and agility tests.) If no, describe the functions that cannot be performed: Education Record High School Name/Location Number of years Completed Did you graduate? YesNo Degree or Diploma College or University Name/Location Number of years Completed Did you graduate? YesNo Degree or Diploma Graduate School Name/Location Number of years Completed Did you graduate? YesNo Degree or Diploma Vocational/Business Name/Location Number of years Completed Did you graduate? YesNo Degree or Diploma Additional Information: Past Employment Record Company 1 Company Name * Position Title * Telephone * Street Address * City * State * Zip/Postal Code * Dates of Employment Ending Salary Name of Immediate Supervisor * Supervisor Title * May We Contact? YesNo Describe your current duties and scope of your primary responsibilities Reason for Leaving Company 2 Company Name Position Title Telephone Street Address City State Zip/Postal Code Dates of Employment Ending Salary Name of Immediate Supervisor Supervisor Title May We Contact? YesNo Describe your current duties and scope of your primary responsibilities Reason for Leaving Company 3 Company Name Position Title Telephone Street Address City State Zip/Postal Code Dates of Employment Ending Salary Name of Immediate Supervisor Supervisor Title May We Contact? YesNo Describe your current duties and scope of your primary responsibilities Reason for Leaving Additional Skills and Training Please list additional skill and training that may be relevant for the position for which you are applying: (e.g. computer skills, language, etc.) Employment References Reference 1 Name Position Title Employer Phone Number Email Reference 2 Name Position Title Employer Phone Number Email Reference 3 Name Position Title Employer Phone Number Email Why do you feel you are qualified for this position? Resume Please paste in your resume I hereby certify that I have not knowingly withheld any information that might adversely affect my chances for employment and that the answers given by me are true and correct to the best of my knowledge. I further certify that I, the undersigned applicant, have personally completed this application. I understand that any omission or misstatement of material fact on this application or on any document used to secure employment shall be grounds for rejection of this application or for immediate discharge if I am employed, regardless of the time elapsed before discovery. Please leave this field empty.