Employment

Position Applied For

Date of application(Required)

How did you hear about us?(Required)

Friend

Walk-in

Employment Agency

Relative

Other

Other(Required)

Name(Required)

First Middle Last

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone(Required)

Social Security Number(Required)

Are you over the age of 18?

Yes

Have you ever filed an application with us before?(Required)

Yes

If Yes, give date(Required)

Have you ever been employed with us before?(Required)

Yes (La Junta or Rocky Ford)

If Yes, give date(Required)

Are you currently employed?(Required)

Yes

May we contact your present employer?(Required)

Yes

Are you prevented from lawfully becoming employed in this country because of visa or immigration status?(Required)

Yes

Proof of citizenship or immigration status will be required upon employment

On what date would you be available for work?(Required)

Are you currently on “lay-off” status and subject to recall?(Required)

Yes

Education

High School Diploma or GED?

HS Diploma

GED

Highest Grade Completed In School

High School Name:

Location:

Course of study

Training Beyond High School (College, University or Other Schools)(Required)

Yes

College Degree(Required)

Yes

Highest Grade Completed In College(Required)

College Name:(Required)

Location:(Required)

Degree Course of study(Required)

References

Give name, address and telephone number of three references that are not related to you and are not previous employers

Name:

Address:

Phone:

Name:

Address:

Phone:

Name:

Address:

Phone:

Employment Experience

Start with you present of last job. Include any job-related military service assignments and volunteer activities

Previous Job 1

Employer:

Type of Business:

Street:

City:

Address

State ZIP Code

Job Title:

Reason For Leaving:

Employment Status

Telephone Number:

Work Performed:

From (Month & Year):

To (Month & Year):

Previous Job 2

Employer:

Street:

City:

Address

State ZIP Code

Job Title:

Reason For Leaving:

Employment Status

Telephone Number:

Work Performed:

From (Month & Year):

To (Month & Year):

Previous Job 3

Employer:

Street:

City:

Address

State ZIP Code

Job Title:

Reason For Leaving:

Employment Status

Telephone Number:

Work Performed:

From (Month & Year):

To (Month & Year):

SPECIAL SKILLS AND QUALIFICATIONS

Summarize special job-related skills and qualification acquired from employment or other experience.

SPECIAL SKILLS AND QUALIFICATIONS

APPLICANT’S STATEMENT

I certify that answers given herein are true and complete to the best of my knowledge. I authorize investigation of all statements contained in this application for employment as may be necessary in arriving at an employment decision. I hereby understand and acknowledge that, unless otherwise defined by mutual agreement, the employment relationship which I am seeking with this organization is of an “AT WILL” nature, which means that the Employee my resign at anytime and the Employer my discharge the Employee at any time with or without cause. It is further understood that an authorized executive of this organization specifically acknowledges this in writing. Any applicant who knowingly or willfully makes false statement of any material fact or thing in this application is guilty of perjury in the second degree as defined in section 18-8-503, C.R.S., and, upon conviction thereof, shall be punished accordingly. In the event of employment, I the undersigned understand that false or misleading information given in my application or interview(s) may result in discharge. I also understand that I am required to abide by all rules and regulation of the Employer.

Applicant Signature(Required)

(Type Name)

Date(Required)

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