BAYSHORE RECYCLING CORPORATION
Application for Employment

Equal access to programs, services and employment is available to all persons. Those applicants requiring accomodation to the application and/or interview process should contact a representative of the Personnel Department.

Position(s) applied for:      Date of application:

Referral Source:
Advertisement     Employee     Relative     Government Emp. Agency
Private Emp. Agency     Other
Name of source (if applicable):

Last Name:    First Name:    Middle Name:
 
E-mail Address*: *
 
Street Address:
 
City:    State:    Zip Code:
 
Telephone Number:    Social Security Number:
 
If necessary, best time to call you at home is:
 
May we contact you at work? Yes   No
If yes, work number:    Best time to call at work:
 
If you are under 18 can you furnish a work permit? Yes   No
 
Have you filed an application here before? Yes   No
If yes, give date:
 
Have you ever been employed here before? Yes   No
If yes, give dates: From to
 
Are you legally eligible for employment in the U.S.? Yes   No
Proof of U.S. Citizenship or immigration status will be required upon employment.)
 
Date available for work:
 
Type of employment desired:
Full time     Part time     Temporary     Seasonal     Educational Co-op
 
Are you on layoff and subject to recall? Yes   No
Will you relocate if job requires it? Yes   No
Will you travel if job requires it? Yes   No
Are you able to meet the attendance requirements of the position? Yes   No
Will you work overtime if required? Yes   No
Have you ever been bonded? Yes   No
 
Have you been convicted of a felony in the last seven (7) years? Yes   No
If yes, please explain:

 
Driver's license number (if job-related):      State:

EMPLOYMENT HISTORY

List your last four (4) employers, assignments or volunteer activities, starting with the most recent, including military experience. Explain any gaps in employment in comments section below.

Most Recent Position
Employer:
Address:
Phone:
Dates: From to
Job Title:
Immediate Supervisor and Title:
Reason for leaving:
Starting hourly rate/salary: $
Final hourly rate/salary: $
 
Summarize the nature of the work performed and job responsibilities:

 
May we contact for reference? Yes   No   Later


2nd Most Recent Position
Employer:
Address:
Phone:
Dates: From to
Job Title:
Immediate Supervisor and Title:
Reason for leaving:
Starting hourly rate/salary: $
Final hourly rate/salary: $
 
Summarize the nature of the work performed and job responsibilities:

 
May we contact for reference? Yes   No   Later


3rd Most Recent Position
Employer:
Address:
Phone:
Dates: From to
Job Title:
Immediate Supervisor and Title:
Reason for leaving:
Starting hourly rate/salary: $
Final hourly rate/salary: $
 
Summarize the nature of the work performed and job responsibilities:

 
May we contact for reference? Yes   No   Later


4th Most Recent Position
Employer:
Address:
Phone:
Dates: From to
Job Title:
Immediate Supervisor and Title:
Reason for leaving:
Starting hourly rate/salary: $
Final hourly rate/salary: $
 
Summarize the nature of the work performed and job responsibilities:

 
May we contact for reference? Yes   No   Later


Comments
Comments (including explanation of any gaps in employment):


Skills and Qualifications:
Summarize any special training, skills, licenses, certificates and/or characteristics of yourself that may qualify you as being able to perform job-related functions for the position for which you are applying:

EDUCATIONAL BACKGROUND (if job related)

A. List last three (3) schools attended, starting with the most recent. B. List number of years completed. C. Indicate degree or diploma earned. D. Grape Point Average or Class Rank E. Major and minor field of study (if applicable)
A. School B. Years
Completed		 C. Degree /
Diploma		 D. GPA /
Class Rank		 E. Major F. Minor

List any foreign language(s) you know and check the boxes that describe your skill level
Language Speak Some Speak Fluently Read Write

REFERENCES

List name and telephone number of three business/work references who are not related to you and are not previous supervisors. If not applicable, list three school or personal references who are not related to you.
Name Telephone (with area code) Years Known


List professional, trade, business, or civic associations and any offices held. (Exclude memberships which would reveal sex, race, religion, national origin, age, color, disability or other protected status.)
Organization Offices Held

List special accomplishments, publications, awards. (Exclude information which would reveal sex, race, religion, national origin, age, color, disability or other protected status.)

List any additional information you would like us to consider:

It is understood and agreed upon that any misrepresentation by me on this application will be sufficient cause for cancellation of this application and/or separation from the employer's service if I have been employed.

I give the employer the right to investigate all references and to secure additional information about me, if job-related. I hereby release from liability the employer and its representatives for seeking such information and all other persons, corporations or organizations for furnishing such information.

The employer is an Equal Opportunity Employer. The employer does not discriminate in employment and no question on this application is used for the purpose of limiting or excusing any applicant's consideration for employment on a basis prohibited by local, state or federal law.

This application is current for only 60 days. At the conclusion of this time, if I have not heard from the employer and still wish to be considered for employment, it will be necessary to fill out a new application.

I understand that just as I am free to resign at any time, the employer reserves the right to terminate my employment at any time, with or without cause and without prior notice. I understand that no representative of the employer has the authority to make any assurances to the contrary.

I understand it is this company's policy not to refuse to hire a qualified individual with a disability because of this person's need for an accomodation that would be required by the ADA.

The position you are applying for involves safety sensitive functions.
Are you always fit for duty for such a position? Yes   No

Initialing this box is the equivalent of signing a paper application.
Initials*: *     Date*: (MM/DD/YYYY) *

Clicking the button below will submit your application. Please be sure that all of the information you provided is accurate and complete before clicking this button!
 
All entries in this form with a * are required (your e-mail address at the beginning, your initials and the date at the end) The form cannot be properly submitted if any of these fields are left blank.

AFFIRMATIVE ACTION
VOLUNTARY INFORMATION
(Completion of information below is voluntary)

We consider applicants for all positions without regard to race, color, religion, sex, national origin, age, disability, veteran status or any other legally protected status.


This form is to be completed by the applicant, is not for interview purposes, and is to be filed separately from the application. This information is used to satisfy the Affirmative Action requirements of Section 503 of the Rehabilitation Act or as necessitated by another federal law or regulation.

As required, we comply with government regulations including Affirmative Action obligations where they apply

In an effort to comply with requirements regarding government recordkeeping, reporting and other legal obligations, we ask that you complete this applicant data survey. Your cooperation is appreciated.

Please be advised that this survey is not a part of your official application for employment. It is considered confidential information that will not be used in any hiring decision.


Position(s) applied for:      Date of application:

Referral Source
Walk-in     Government Emp. Agency     Private Emp. Agency
Employee     Relative     School
Advertisement - Source:
Other
Name of person who referred you (if applicable):

Applicant Information
Last Name:    First Name:    Middle Name:
 
E-mail Address*: *
 
Street Address:
 
City:    State:    Zip Code:
 
Telephone Number:
 
Male     Female

Please check one of the following Equal Employment Opportunity Identification Groups:
White     Black (not of Hispanic origin)     Hispanic
American Indian / Alaskan Native     Asian/Pacific Islander

Special Notice
To Vietnam Era Veterans, Disabled Veterans and Individuals with physical or mental disabilities:
 
Government contractors subject to the Vietnam Era Veterans Readjustment Act of 1974 and the Rehabilitation Act of 1973 are required to take affirmative action to employ and advance in employment qualified disabled veterans, veterans of the Vietnam Era and qualified handicapped individuals.
 
You are invited to volunteer this information, if you qualify, to assist in proper placement and determining reasonable accomodation. This information will be considered confidential. Refusal to provide this information will not adversely affect your consideration for employment.
 
If you so wish to be identified, please check if any of the following are applicable:
Vietnam Era Veteran (served between 1964-1975)
Disabled Veteran
Individual with a disability
 
Clicking this button will submit the Affirmative Action form. Please be sure that all of the information you provided is accurate and complete before clicking this button!

NOTE: Clicking this button WILL NOT submit the job application above... just the affirmative action info. form!


Get me back to the Bayshore Recycling site
without submitting any information!