Schumacher Application Form

Application Form

First Name:

Last Name:

Street Address:

Address Line 2:

State / Province / Region:

City:

Zip/Postal Code:

Country:

Daytime Phone

Evening Phone

Enter Email

Confirm Email

Are you a U.S. citizen or otherwise authorized to obtain lawful employment in this country?
YesNo

Position applying for:

Date available for work?

Wage desired?

Desired hours?
Full-TimePart-TimeSeasonal

Are you 18 years or older?
YesNo

Shifts available to work?

Will you work overtime/alternative shift, if asked?
YesNo

Have you ever applied here before?
YesNo
*If so, when?

Have you been referred for employment by one of our current/past employees?
YesNo
*If so, who?

Have you ever pleaded guilty to or been convicted of a misdemeanor or felony?
YesNo

Education and Training

High School

Name & Location of School:

# of years attended

Did you graduate?
YesNo

Subjects Studied

College/ Tech School

Name & Location of School:

# of years attended

Did you graduate?
YesNo

Subjects Studied

Military

Name & Location of School:

# of years attended

Did you graduate?
YesNo

Subjects Studied

Skills

Do you have keyboard or typing skills?
YesNo

*If so, how many WPM?

Areas of expertise/study

Describe computer software you are familiar with

Describe any other training you consider relevant to the position you are applying. - Include any certifications or professional associations:

Work Experience/Former Employees

Provide complete and specific information. Start with your current or most recent job. Include self-employment and military service. For part-time work, show the average number of hours per week. Show any changes in job title for the same employer as a separate position.

Are you currently employed?
YesNo

*If so, may we inquire of your present employer?
YesNo

Current/Most Recent Employer

Employer

Supervisor

Duties

City/State

Phone

Last rate of pay

From (Month & Year)

To (Month & Year)

Reason for leaving

Employer 2

Employer

Supervisor

Duties

City/State

Phone

Last rate of pay

From (Month & Year)

To (Month & Year)

Reason for leaving

Employer 3

Employer

Supervisor

Duties

City/State

Phone

Last rate of pay

From (Month & Year)

To (Month & Year)

Reason for leaving

References

PERSONS NOT RELATED TO YOU

Reference 1

First Name

Last Name

City/State

Phone

Business

Relationship

Reference 2

First Name

Last Name

City/State

Phone

Business

Relationship

Reference 3

First Name

Last Name

City/State

Phone

Business

Relationship

Authorization, Release and Certification

Your application will not be processed unless you have read and signed the Authorization, Release and Certification.

First Name:

Last Name:

I certify that all information on this application is true, complete, and correct to the best of my knowledge. I understand that any false or misleading statements by me, or material omissions of information requested of me, may result in rejection of my application or, if employed, my immediate dismissal. I hereby give permission to the employer to seek to verify and supplement the information set forth in the application. I release from all liability or legal claims every person seeking or providing information, whether oral or written. A photocopy of this release shall be as valid as the original, and may be relied upon by all persons providing information. I understand that I may be required to submit to a medical examination if offered a position conditioned on such examination. I also understand that I may be required to submit to testing for controlled substances or other drugs. I understand this application will be considered inactive after ninety days. I certify I have read (or have had read to me) and understand this authorization, release and certification.ALL QUALIFIED APPLICANTS WILL RECEIVE CONSIDERATION WITHOUT REGARD TO RACE, CREED, COLOR, SEX, RELIGIONAGE, NATIONAL ORIGIN, MARITAL STATUS, HANDICAPPED, VETERAN OR ANY LEGALLY PROTECTED STATUS.

Date

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