Application for EmploymentWe consider applicants for all positions without regard to race, color, religion, sex, national origin, age, marital or veteran status, the presence of non-job-related medical condition or disability, or any other legally protected status.Location in wich Applying*East YorkRed LionWrightsvilleDown Town YorkMount WolfName* First Middle Last Email* Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Phone*Social Security Number*Position Applied For*Date of Application How Did You Learn About Us? Advertisemnt Friend Walk-In Employment Agency Relative Other Please ExplainIf you are under 18 years of age can you provide required proof of your eligibility to work? Yes No Have you ever filed an application with us before? Yes No If Yes, Give Date: Have you ever been employed with us? Yes No If Yes, Give Date: Are you currently employed? Yes No May we contact your present employer? Yes No Are you prevented from lawfully becoming employed in this country because of Visa or Immigration Status? Yes No On what date would you be available for work?Are you available to work: Full Time Part Time Temporary If applying for Part-time, number of hours per week:Are you currently on “lay-off” status and subject to recall? Yes No Have you ever been convicted of a criminal offense (felony or misdemeanor)? Yes No (Convictions for marijuana-related offenses that are more than two years old need not be listed). (Do not include convictions while a minor and/or convictions sealed by court order). If yes, please state nature of offense(s), date(s), city and State and disposition. Note: An affirmative answer will not necessarily result in disqualification for employmentIf Yes, Please ExplainEducation - High SchoolSchool NameLocationCheck Years Completed 9 10 11 12 Did You Graduate? Yes No Education - Undergrad College/UniversitySchool NameLocationCheck Years Completed 1 2 3 4 Did You Graduate? Yes No Education - Graduate / ProfessionalSchool NameLocationCheck Years Completed 1 2 3 4 Special SkillsDescribe any specialized training, apprenticeship, skills and extra-curricular activities.HonorsDescribe any honors you received.Additional InfoState any additional information you feel may be helpful to us in considering your application.Employment ExperienceStart with your present or last job. Include any job-related military assignments and volunteer activities. You may exclude organizations, which indicate race, color, religion, gender, national origin, disability or other protected status.1. Employer's NameStart Date: End Date: Starting Wage:Final Wage:Supervisor: First Last Phone:Job Title:Reason for Leaving:Work Performed2. Employer's NameStart Date: End Date: Starting Wage:Final Wage:Supervisor: First Last Job Title:Reason for Leaving:Work Performed3. Employer's NameStart Date: End Date: Starting Wage:Final Wage:Supervisor: First Last Job Title:Reason for Leaving:Work PerformedSpecial Skills and QualificationsSummarize special job-related skills and qualifications acquired from employment or other experience.Applicant’s StatementI hereby certify that the information on this application is correct and complete to the best of my knowledge. I understand that falsification or omission of any material information on this application or in the interviewing process or in my resume, or failure to pass the physical examination, if I receive a job offer, may be considered sufficient cause of immediate termination. I understand that this application for employment shall be considered active for a period of time not to exceed 45 days. Any applicant wishing to be considered for employment beyond this time period should inquire as to whether or not applications are being accepted at that time. I agree to have any of the statements herein, as well as my background investigated by the company or its agents. I understand that the background investigation may include, but is not limited to, reviewing my education, employment history, credit history, professional license, and public records and personal references. In consideration for reviewing my application and other related information, I hereby waive and release the company, its employees and agents, and all other entities and persons, and their respective employees and agents from any claims that I might have, including defamation and invasion of privacy, arising out of any verbal or written inquiries and/or any verbal or written responses related to investigation of my background as well as the use of disclosure of such information. I understand that all disputes arising out of my employment with the Company will be resolved by binding arbitration, and that, if hired, I will be presented with an Arbitration Agreement. I agree that if employed, I will abide by all policies and procedures established by the employer. I hereby understand and acknowledge that, unless otherwise defined by applicable law, any employment relationship with this organization is of an “at will” nature, which means that the employee may resign at any time, that the employer may terminate my employment at any time, with or without cause. It is further understood that this “at will” employment relationship may not be changed by any written document or by conduct unless such change is specifically acknowledged in writing by the President/CEO of the employer. This constitutes my entire agreement with the company with regard to the matters set forth in this paragraph. By submitting this form, you agree that all of the above information is true and as accurate to the best of you ability.