Employment application

Applicant Information

Name*

First Middle Last

Address

Street Address City State ZIP Code

Telephone #*

Cellular/Other Phone #

E-mail Address*

Position Applied For

Date of Application

Attach Resume (please limit size to 2 megabytes)

Accepted file types: jpg, gif, png, pdf, Max. file size: 2 GB.

Allowed file extensions: jpg, gif, png, pdf

Additional Applicant Information

Referral Source (Please check the appropriate category and then list the source below)

Please list your source

If you are under 18 and it is required, can you furnish a work permit?

Yes
No

If no, please explain

Have you ever been employed here before?

Yes
No

If yes, Employed From What Start to End Date?

( mm/dd/yyyy - mm/dd/yyyy )

Are you legally eligible to work in the United States? (In compliance with applicable law, all persons hired will be required to verify identity and eligibility to work in the United States and to complete the required employment eligibility verification on form upon hire.)

Yes
No

Date available for work

Type of Employment desired

Able to meet the attendance requirements of the position?

Yes
No
N/A

Will you work overtime if required?

Yes
No

If no, please explain

Are you able to perform the "essential functions" of the job?

Yes
No
Need more information about the job's essential functions to respond

Have you ever been convicted of a crime that has not been expunged by a court? (A conviction will not constitute an automatic bar of employment and will be considered only as it relates to the job in question.)

Yes
No

If yes, please provide date(s) and details

Have you entered into an agreement that might restrict your ability to work?

Yes
No

If yes, please explain

Employment History

Employer

Date Employed From

Date Employed To

Phone Number

City & State

Pay

Starting Job Title

Final Job Title

Immediate Supervisor and Title (for most recent position held)

Why did you leave?

Summarize the type of work performed and job responsibilities

What did you like most about your position?

What were things you liked least about the position?

May we contact for reference?

Yes
No

Email Address

Employer

Date Employed From

Date Employed To

Phone Number

City & State

Pay

Starting Job Title

Final Job Title

Immediate Supervisor and Title (for most recent position held)

Why did you leave?

Summarize the type of work performed and job responsibilities

What did you like most about your position?

What were things you liked least about the position?

May we contact for reference?

Yes
No

Email Address

Please explain any gaps in your employment

Have you ever been fired or asked to resign from a job?

Yes
No

If yes, please explain

Skills & Qualifications

Summarize any special skills

Educational Background

School (Include City and State)

Years completed

Completed

Yes
No

Is there any information you want us to know about you?

Applicant Statement

I certify that all information I have provided in order to apply for and secure work with this employer is true, complete and correct to the best of my knowledge. I understand that false, misleading, or incomplete information given in my application, resume, other employment documents, or interview(s) may disqualify me from further consideration for employment or lead to me immediate dismissal from employment if I am hired.

I expressly authorize, without reservation, the employer, its representatives, employees or agents to contact and obtain information from all references (personal and professional) and to otherwise notify the accuracy of all information provided by me in this application, resume, or job interview. I hereby release BPI from any/all liability of whatever kind in nature which, at any time, could eresult from obtaining and having an employment decision based on such information. I also authorize any person and/or entity named in this application on form to provide the Company relevant information that may be useful in making a hiring decision, and I release such persons and identities from any legal liability for making such statements.

I understand that this employer does not unlawfully discriminate in employment and no question on this application is used for the purpose of limiting or eliminating any applicant from consideration for employment on any basis prohibited by applicable local, state or federal law.

I understand that this application remains current for only 30 days. At the conclusion of that time, if I have not heard from the employer and wish to be considered for employment, it will be necessary for me to reapply and fill out a new application.

I understand that neither this application nor any statement made to me by BPI creates a contract of employment. I also understand and agree that, if I am hired, my employment is at-will and that I am free to resign at any time, with or without cause and with or without prior notice, and the employer may terminate my employment at any time, with or without cause and with or without notice, except as may be required by law. I understand that no supervisor or representative of the employer is authorized to make any assurance to the contrary.

I also understand that if I am hired, I will be required to provide proof of identity and legal authorization to work in the United States and that federal immigration laws require me to complete an I-9 form in this regard.

NOTE: This company complies with Indiana Law prohibiting smoking in enclosed areas within places of employment.

DO NOT SIGN UNTIL YOU HAVE READ THE ABOVE APPLICANT STATEMENT
I certify that I have read, fully understand and accept all terms for the foregoing Applicant Statement.

Signature of Applicant (please type your full name)*

Date*