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Burlington Employment Application

*Note: All fields marked with an asterisk (*) are required.

Pre-Employment Information

*Name*SSN*Address*Phone #Mobile #*Car
Shift(s) Available

Preferred Position

Skills & CertificationsComments

Application for Employment

We are an equal opportunity employer and do not unlawfully discriminate in employment. No question on this application is used for the purpose of limiting or excluding any applicant from consideration for employment on a basis prohibited by local, state or federal law. Equal access to employment, services and programs is available to all persons. Those applicants requiring accommodation to the application and/or interview process should notify a representative of the organization.

*Applicant NamePosition(s) applied for or type of work desired*Date you will be able to start work
Type of employment desired

*Do you have any objection to working overtime if necessary?
*Are you willing to travel if required to in this position?
*Have you ever been previously employed by our organization?
*Can you submit proof of legal employment authorization and identity?
*Have you ever been convicted of a felony?
If yes, please explain (a conviction will not automatically bar employment)*May we contact your present employer?
*Have you ever been employed by a temporary employment service before?

Employment History

Please provide all employment information for your past 3 employers starting with the most recent.

Employer #1Position heldAddressTelephone #Immediate Supervisor and titleDates employed: From
Dates employed: To
Salary

Employer #2Position heldAddressTelephone #Immediate Supervisor and titleDates employed: From
Dates employed: To
Salary

Employer #3Position heldAddressTelephone #Immediate Supervisor and titleDates employed: From
Dates employed: To
Salary