Employment Application Employment Application Equal Opportunity Employer EmailThis field is for validation purposes and should be left unchanged.Are you legally authorized to work in the United States? Yes No Personal InformationLast Name, First NameContact Telephone No. (Whose number is this?)Current Address (include former address if less than 2 years)City, State, Zip CodeEmployment DesiredPosition Applied ForDate you can Start MM slash DD slash YYYY Salary DesiredAre you employed now? Yes No Have you ever worked for or applied for a job with Valley Enterprises? Yes No If “YES”, when and reason for leaving.Are you able to perform the essential functions of the job for which you are applying for, with or without reasonable accommodation? Yes No Schedule Available to WorkMonday Monday ShiftsDayAfternoonGraveyardChoose available shiftsTuesday Tuesday ShiftsDayAfternoonGraveyardChoose available shiftsWednesday Wednesday ShiftsDayAfternoonGraveyardChoose available shiftsThursday Thursday ShiftsDayAfternoonGraveyardChoose available shiftsFriday Friday ShiftsDayAfternoonGraveyardChoose available shiftsSaturday Saturday ShiftsDayAfternoonGraveyardChoose available shiftsSunday Sunday ShiftsDayAfternoonGraveyardChoose available shiftsEmployment Desired Full-Time Only Part Time Only Full-Time OR Part-Time How many hours can you work a day?Can you work nights? Yes No Employment HistoryStart Date MM slash DD slash YYYY End Date MM slash DD slash YYYY Name, Address, & Telephone of Previous EmployerPosition & SupervisorReason for LeavingStart Date MM slash DD slash YYYY End Date MM slash DD slash YYYY Name, Address, & Telephone of Previous EmployerPosition & SupervisorReason for LeavingStart Date MM slash DD slash YYYY End Date MM slash DD slash YYYY Name, Address, & Telephone of Previous EmployerPosition & SupervisorReason for LeavingStart Date MM slash DD slash YYYY End Date MM slash DD slash YYYY Name, Address, & Telephone of Previous EmployerPosition & SupervisorReason for LeavingPersonal HistoryHave you ever been convicted of a felony crime? Yes No Do you have a reliable method of getting to work? Yes No ReferencesList three referencesNameAddress & TelephoneBusinessYears Known Add RemoveAuthorization & SignatureAuthorization I certify that the facts contained in this Employment Application are true and complete to the best of my knowledge and understand that if employed, falsified statements on this Application shall be grounds for dismissal regardless of the time elapsed after discovery. As a part of the reference checking process, unless specifically checked in this section, Valley Enterprises may contact other persons not listed in the employment application: Valley Enterprises may not contact anyone not stated on this Employment Application. I understand and agree that no representative of the Company has any authority to enter into any agreement for employment for any specified period of time, or to make any agreement contrary to the foregoing, unless it is in writing and signed by an authorized Company representative. I understand and agree that, if hired, my employment will be terminable at will and may be terminated by Valley Enterprises or me at any time and for any reason. If employed, I will be required to provide original documents that verify my identity and right to work in the United States under the Immigration Reform and Control Act (IRCA) of 1986. The document(s) provided will be used for completion of Form I-9. All new hires are processed and cleared through the E-Verify system. This waiver does not permit the release or use of disability-related or medical information in a manner prohibited by the Americans with Disabilities Act (ADA) and other relevant federal and state laws. If employed, I understand that Valley Enterprises may unilaterally change or revise its benefits, policies and procedures and such changes may include reduction in benefits. I also understand that: (1) the Company may have a drug and alcohol policy that provides for pre-employment substance abuse testing as well as testing after employment; (2) consent to and compliance with such policy is a condition of my employment; and (3) continued employment is based on the successful passing of drug/alcohol testing under such policy. Consent I acknowledge that I have read and agree to the above statements and that all information is true and correct.Date MM slash DD slash YYYY Full Legal Name
