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Application
THIS APPLICATION IS NOT AN EMPLOYMENT CONTRACT but merely is intended to evaluate suitability for employment. It is the policy of the company to provide equal employment to all qualified persons without discrimination on the basis of sex, race, color, religion, age, national origin, citizenship, disability, veteran status, or any other status protected under local, state or federal law. It is also the policy of the company to have the option of conducting pre-employment screening before a job offer is made. If a job offer is made, employment may be contingent upon the successful completion of a pre-employment drug screening and/or medical examination. This application will remain active for 3 years.
Name
*
First
Last
Email
*
Address
*
Street Address
City
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Contact Phone
*
What position are you applying for?
*
Education
High School
*
Location of School
*
Diploma
*
Yes
No
Continued Education
College / University / Trade School
Location of School
Type of Degree / Certification
Area of Study
Diploma
Yes
No
Applicant Questions
Date you can start
*
MM slash DD slash YYYY
Do you prefer?
*
Full-time
Part-time
Open
Can you work
Weekends
Days
Evenings
Availability
Mondays
Tuesdays
Wedsnesdays
Thursdays
Fridays
Saturdays
Sundays
Anytime
Are you at least 18 years of age and legally eligible to work for our company in the United States?
*
Yes
No
Have you worked for this business before?
*
Yes
No
If so, when?
*
MM slash DD slash YYYY
Have you received a description of the job or been made aware of the essential functions of the job for which you are applying?
*
Yes
No
Do you understand the job requirements?
*
Yes
No
If no, please explain
*
Have you ever been discharged or asked to resign from a job?
*
Yes
No
If yes, please explain
*
Have you ever been convicted of or pled guilty to a felony or crime other than a minor traffic citation?
*
Yes
No
If yes, please explain
*
Are you a military veteran or member of the reserves?
*
Yes
No
If yes, please provide status, branch, rank, and MOS
*
Employment History
Current or Previous Employer
Supervisor Name & Position
Employer Phone
Start Date
MM slash DD slash YYYY
End Date
MM slash DD slash YYYY
Title / Position Held
Duties / Responsibilites
Reason for Leaving
Are you currently employed here?
Yes
No
If yes, may we contact them?
Past Employment
Previous Employer
Supervisor Name & Position
Employer Phone
Start Date
MM slash DD slash YYYY
End Date
MM slash DD slash YYYY
Title / Position Held
Duties / Responsibilites
Reason for Leaving
References
Reference Name
*
Relationship
*
Address
*
Street Address
City
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Contact Phone
*
Reference #2
Reference Name
*
Relationship
*
Address
*
Street Address
City
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Contact Phone
*
Application Agreement
*
It is Meals on Wheels of NWI’s policy that equal employment opportunities be available to all employees and applicants without regard to race, sex, color, religion, creed, national origin, age, disability, genetic information, participation in military service or any other protected status.
I understand that neither the completion of this application nor any other part of my consideration for employment establishes any obligation to hire me. If I am hired, I understand that either Meals on Wheels or I can terminate my employment at any time and for any reason, with or without cause and without prior notice. I understand that no representative of Meals on Wheels has the authority to make any assurance to the contrary.
I authorize the employer, its representatives, employees, or agents to contact and obtain information from all references, employers, public agencies, licensing authorities, and educational institutions provided for employment reference checks and to otherwise verify the accuracy of all information provided by me. I hereby waive all rights and claims I may have regarding the employer, its agents, employees or representatives for seeking, gathering and using such information in the employment process and all other person’s corporations or organizations for furnishing such information about me.
I attest with my signature below that I have given true and complete information on this application. No requested information has been concealed. If any information I have provided is false, incomplete, has been misrepresented or concealed, I understand that this will constitute cause for the denial of employment or immediate dismissal regardless of the date of discovery.
I agree to the application agreement.
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