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Employment Application

After you submit your application you will be redirected to a confirmation page. If you have not been redirected to the confirmation page your application has not been submitted.

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Personal Information

Job Position Applying For:
First and Last Name:
Preferred Name:
Pronouns:
Home Address:
City:
State:
Zip:
Phone:	()
Email:
How old are you?	Under 16 16 - 17 18 or Over
Are you legally eligible for employment in the United States?	Yes No
Upload a Resume (PDF only):

Availability

	MONDAY	TUESDAY	WEDNESDAY	THURSDAY	FRIDAY
FROM
TO

Available Start Date:
Wage Desired:
Number of Hours Desired Per Week:

Education

	School Name	Major Course of Study	Last Year Completed	Did you graduate?
High School:			1 2 3 4	Yes No
College:			1 2 3 4	Yes No
Other:			1 2 3 4	Yes No

Have you served in the US Armed Forces? If so, what branch?
List any additional training or skills that may be relevant to the position that you are applying for:

Other Information

Have you ever been employed by One Stop?	Yes No
If yes, previous dates of employment:
Can you, with or without a reasonable accommodation, perform the essential functions of the job for which you applied?	Yes No
If no, please explain.
Have you ever been convicted of a felony or have felony charges pending?	Yes No
If yes, please explain.
How many pounds can you lift on a continuous basis?
Would you be willing to take a drug test?	Yes No

Employment History

Current or Most Recent Employer

Company Name:
Address:
Phone Number:	()
Start Date:
End Date:
Start Wage:
End Wage:
Hours Worked Per Week:
Job Title:
Job Duties:
Reason for Leaving:

Next Most Recent Employer

Company Name:
Address:
Phone Number:	()
Start Date:
End Date:
Start Wage:
End Wage:
Hours Worked Per Week:
Job Title:
Job Duties:
Reason for Leaving:

Next Most Recent Employer

Company Name:
Address:
Phone Number:	()
Start Date:
End Date:
Start Wage:
End Wage:
Hours Worked Per Week:
Job Title:
Job Duties:
Reason for Leaving:

References

Reference 1

Name:
Company:
Phone Number:	()
Position:

Reference 2

Name:
Company:
Phone Number:	()
Position:

Reference 3

Name:
Company:
Phone Number:	()
Position:

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