Employment Application We are an Equal Opportunity Employer Question Title * 1. Contact Information Name * Address * Address 2 City/Town * State/Province * -- select state -- AL AlabamaAK AlaskaAS American SamoaAZ ArizonaAR ArkansasCA CaliforniaCO ColoradoCT ConnecticutDE DelawareDC District of ColumbiaFM Federated States of MicronesiaFL FloridaGA GeorgiaGU GuamHI HawaiiID IdahoIL IllinoisIN IndianaIA IowaKS KansasKY KentuckyLA LouisianaME MaineMH Marshall IslandsMD MarylandMA MassachusettsMI MichiganMN MinnesotaMS MississippiMO MissouriMT MontanaNE NebraskaNV NevadaNH New HampshireNJ New JerseyNM New MexicoNY New YorkNC North CarolinaND North DakotaMP Northern Mariana IslandsOH OhioOK OklahomaOR OregonPW PalauPA PennsylvaniaPR Puerto RicoRI Rhode IslandSC South CarolinaSD South DakotaTN TennesseeTX TexasUT UtahVT VermontVI Virgin IslandsVA VirginiaWA WashingtonWV West VirginiaWI WisconsinWY Wyoming ZIP/Postal Code * Country Email Address * Contact Phone Number * OK Question Title * 2. Home Phone Number OK Question Title * 3. Cell Phone Number OK Question Title * 4. Employment Desired (Position/s Applying For) Position 1 Position 2 Position 3 OK Question Title * 5. Have you ever applied to or worked forour Company before? Yes No OK Question Title * 6. If yes, when? Date / Time Date OK Question Title * 7. Do you have any friends or relatives working forour Company? Yes No OK Question Title * 8. If yes, state name(s) and relationship: Name, Relationship Name, Relationship OK Question Title * 9. How did you learn about our Company? OK Question Title * 10. If hired, would you have a reliable means of transportation to and from work? Yes No OK Question Title * 11. Are you at least 18 years old? (If under 18, hire is subject to verification that you are of minimum legal age.) Yes No OK Question Title * 12. If hired, can you present evidence of your U.S. citizenship or proof of your legal right to live and work in this country? Yes No OK Question Title * 13. Are you able to perform the essential functions of the job for which you are applying, either with or without reasonable accommodation? Yes No OK Question Title * 14. If no, describe the functions that cannot be performed. (Note: We comply with the ADA and consider reasonable accommodation measures that may be necessary for eligible applicants/employees to perform essential functions. Hire may be subject to passing a medical examination, and to skill and agility tests.) OK NEXT