substrom | Employee Registration

It is our policy to comply with all applicable state and federal laws prohibiting discrimination in employment based on race, age, color, sex, religion, national origin, disability or other protected classifications. Please carefully read and answer all quetions. You will not be considered for employment if you fail to completely answer all the questions on this application. You may attach a resume, but all questions must be answered.

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Name (last, first, middle)

Street Address

City

State

Zip

Home Cellphone/Mobile number

Cellphone/Mobile Number

Date you can start work

Date of Birth

Do you have a Hight School Diploma or GED?

Yes No

Hours

Fulltime Parttime

Are you authorized to work in the U.S. on an unrestricted basis?

Yes No

Have you ever been covicted of a felony? (Convictions will not necessarily disqualify an applicant for employment) If yes, explain

Yes No

Explain

Have you been told the essential functions of the job or have you been viewed a copy of the job description listing the essential functions of the job?

Yes No

Can you perform these essential functions of the job with or withut reasonable accommodations?

Yes No

Attached resume

I certify that the facts set forth in this Application for Employment are true and complete to the best of my knowledge. I understand that if I am employed, false statements, omissionos or misrepresentations may result in my dismissal. I authorize the Employer from any liability. The employer may contact any listed references on this application. I acknowledge and understand that the company is an "at will" employer. Therefor, any employee ( regular, temporary, or other type of category employee) may resign at any time, just as the employer may terminate the employment relationship with any employee at any time, with or without cause, with or without notice to the other party.

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