Employee’s Form Full Name Other names used (aliases) Address City State ZIP Email Alternative Email Phone (primary) Alternative Phone Date of Birth Emergency Contact Position applying for Desired start date Type of employment Full-time Part-time Seasonal Availability (days/hours) Are you available for overtime? Yes No Are you legally authorized to work in the U.S.? Yes No (Proof required upon hire: e.g., passport, birth certificate + SS card, or I-9 docs) Have you ever been convicted of a felony or misdemeanor related to workplace safety, theft, or property damage? Yes No If Yes, explain (date, offense, disposition) Driver’s license? Yes No State Number Do you have reliable transportation to/from work? Yes No Do you have vehicles available for work use? Yes No If Yes, type(s) of vehicle License plate/state Insurance carrier Employment History (most recent first) Skills / Certifications Certificates (OSHA, CPR, equipment certs) — list and attach copies References (professional) Are you able to perform the essential functions of the job with/without reasonable accommodation? Yes No If no, please explain (optional): Any lifting limitations, allergies to cleaning chemicals, or medical conditions we should know about for safety? (optional) Authorizations & Acknowledgements For Hire Only Employment Status FT PT Temp Notes Submit
