Employment Application

First Name:

Last Name:

Middle Initial:

Street Address:

Apartment/Unit #:

City:

State:

Zip:

Home Phone:

Mobile Phone Number:

Email:

When are you available for employment?:

Now(UTC + 00:00)

Employment Location:

Please put the city or cities you would be interested in working for Pro Cooperative.

Desired Salary:

Please enter your desired salary.

How did you hear about this position?:

If other, please explain:

What work schedule are you seeking?:

Employment authorization:

Are you authorized to work in the United States? (Federal Law requires proof of identity and employment authorization for all new employees.)

Position Applying For:

Previous Employment:

Are you a former Pro Cooperative Employee?

Notes:

If yes, when? Where? Reason for Leaving?

Are you over 18 years of Age?:

Criminal Record:

Have you ever been convicted, entered a plea of no contest, or received a withheld judgement for any criminal offense, misdemeanor or felony? If Yes, Please explain.

Drivers License:

For Driving Positions Only: Do you have a valid driver's license? For non-driving positions enter "Not applicable for position"

Highest level of education completed?:

Please explain:

Include the name of the school and degree/major or list of subjects of special study or training.

Equipment Operations:

If you are an experienced operator of any position-related business/plant machines or equipment, please list above

Other Job Related Skills:

Employment History:

Please include 5 years of past employment History. Please fill in (or copy and paste) your employment. Include explanation of any gaps in employment

References:

Please list the names and phone numbers of three professional references

Upload your Resume:

I understand that this is an application for employment and that no employment contract is being offered at this time. Any material misrepresentation or deliberate omission of a fact in my application may be justification for refusal of, or if employed, termination from employment. It is my understanding that the facility will make a thorough investigation of my entire work and personal history and may verify all data given in my application for employment, related papers, or oral interviews. I authorize such investigation and the giving and receiving of any information requested by the facility and I release from liability any person giving or receiving any such information. I understand that falsification of data so given or other derogatory information discovered as a result of this investigation may prevent my being hired, or if hired may subject me to immediate dismissal. Pro Cooperative is an at-will employer.

Electronic Signature:

Security Code: