Job Application

Please answer each question fully and accurately. No action can be taken on this application until you have answered all questions. In reading and answering the following questions, be aware that none of the questions are intended to imply illegal preferences or discrimination based upon non-job-related information.

Job applied for:(Required)

When can you start?(Required)

Today's Date(Required)

Are you seeking:(Required)

Fulltime Employment

Part-time Employment

Temporary Employment

Name(Required)

First Middle Initial Last

Date of birth:(Required)

Phone(Required)

Email(Required)

Home Address(Required)

Address Line 1 Address Line 2 City State ZIP Code

Are you able to provide proof you are eligible to work in the U.S.?(Required)

Yes

Have you ever applied here?(Required)

Yes

If yes, when?

Ever employed by Nettles?(Required)

Yes

If yes, when?

Have you ever been convicted of any law violation, plea of “guilty” or “no contest”? exclude minor traffic violations(Required)

Yes

If yes, provide details:(Required)

(a conviction will not necessarily disqualify an applicant for employment)

If employed, do you expect to be engaged in any additional business or employment outside of Nettles?(Required)

Yes

Are you currently employed?(Required)

Yes

Have you ever been fired or asked to resign from a job?(Required)

Yes

If yes, provide details:(Required)

For Driving jobs Only: Do you have a valid driver’s license?

Yes

Has your license ever been suspended or revoked in the last three years?

Yes

If yes, provide details:(Required)

Drive license number:

Class of License:

State Licensed in

Check all completed levels of education:

High school

GED

College/University

Vocational/Technical

List all additional certifications (equipment/safety):

Previous Employment

List names of employers in consecutive years with present or last employer listed first. Account for all periods of time including military service any periods of unemployment. Note: A job offer may be contingent upon acceptable references from current/former employers.

Name of Employer:

Dates of Employment (MO/YR):

Job Title and Duties

Phone Number

Name of Employer:

Dates of Employment (MO/YR):

Job Title and Duties

Phone Number

Name of Employer:

Dates of Employment (MO/YR):

Job Title and Duties

Phone Number

Name of Employer:

Dates of Employment (MO/YR):

Job Title and Duties

Phone Number

PLEASE READ EACH CAREFULLY BEFORE SIGNING

I certify that all information provided in the employment application is true and complete. I understand that any false information or omission may disqualify me from further consideration for employment and may result in my dismissal if discovered at a later date.

I authorize the investigation of any or all statements contained in the application. I also authorize, weather listed or not, any person, school, current employer, past employers and organizations to provide relevant information and opinions that may be useful in making a hiring decision, I release such persons and organizations from any legal liability in making such statements.

I understand I may be required to successfully pass a drug screening examination. I hereby consent to a pre- and/or post-employment physical examination as a condition of employment.

I understand that if I extended an offer of employment it may be conditioned upon my successfully passing a complete pre-employment physical examination. I consent to the release of any or all medical information as may deemed necessary to judge my capability to do the work for which I am applying.

I UNDERSTAND THAT THIS APPLICATION, VERBAL STATEMENTS BY MANAGEMENT, OR SUBSEQUENT EMPLOYMENT DOES NOT CREATE AN EXPRESS OR IMPLIED CONTRACT OF EMPLOYMENT NOR GUARNTEE EMPLOYMENT FOR ANY DEFINITE PERIOD OF TIME. ONLY THE PRESIDENT OF THE ORGANIZATION HAS THE AUTHORITY TO ENTER INTO AN AGREEMENT OF EMPLOYMENT FOR ANY SPECIFIED PERIOD AND SUCH AGREEMENT MUST BE IN WRITING, SIGNED BY THE PRESIDENT AND THE EMPLOYEE. IF EMPLOYED, IUNDERSTAND THAT I HAVE BEEN HIRED AT THE WILL OF THE EMPLOYER AND MAY BE TERMINATED AT ANY TIME, WITH OR WITHOUT REASON

I have read, understand and my signature consent to these statements.

(Digital Signature) By typing my full name below, I have read, understand, and consent to the statements above.(Required)

Date(Required)

This application for employment will remain active for a limited time. Ask the organization’s representative for detail.

APPLICATION FOR EMPLOMENT

Previous Employment

PLEASE READ EACH CAREFULLY BEFORE SIGNING