6. Who referred you to our company? _____________________________________
Do you have any friends or relatives who work here? If yes, please list here:
7. Have you applied to our company previously?______ Yes ______ No
If yes, when? ________________________
8. Are you at least 18 years old?______ Yes ______ No
9. Are you willing to work any shift, including nights and weekends? _____ Yes _____ No
If no, please state any limitations:
10. If applicable, are you available to work overtime? _____ Yes _____ No
11. If you are offered employment, when would you be available to begin work?
12. If hired, are you able to submit proof that you are legally eligible for
employment in the United States? _____ Yes _____ No
13. Are you able to perform the essential functions of the job position you seek with
or without reasonable accommodation?______ Yes ______ No
What reasonable accommodation, if any, would you request?
14. Have you ever been convicted of a felony or misdemeanor?
______ Yes, I was convicted of ______________________________ on ____________
(date) in _________________ (city), _______________ (state)
THE EXISTENCE OF A CRIMINAL RECORD DOES NOT CONSTITUTE AN AUTOMATIC
BAR TO EMPLOYMENT UNLESS RELEVANT TO THE TYPE OF EMPLOYMENT.