Apply – The Urban Wood Shop

Name*

First Last

Email*

Address*

Street City State ZIP Code

Phone*

Last 4 of SSN*

Date Available:*

If you are under 18 years of age, can you provide required proof of your eligibility to work?*

Yes
No
N/A

Are you legally eligible for employment in the U.S.?*

Yes
No

Have you ever been employed at The Urban Woodshop before?*

Yes
No

Are you currently employed?*

Yes
No

May we contact your present employer?*

Yes
No

Are you currently on "Lay-Off" status and subject to recall?*

Yes
No

Are you able to meet the attendance requirements of the position?*

Yes
No

Can you travel if the job requires it?*

Yes
No

Have you been convicted of a crime in the last seven (7) years?*

Yes
No

If yes, please explain:

CONVICTION WILL NOT NECESSARILY BE A BAR TO EMPLOYMENT. EACH INSTANCE AND EXPLANATION WILL BE CONSIDERED IN RELATION TO THE POSITION YOU ARE APPLYING.

Driver's License Number*

State*

Do you have reliable transportation to get you to and from work?*

Yes
No

Do you have a CDL?*

Yes
No

JOB INTEREST

Position applying for*

Referred by*

Wage Desired*

Per*

Check each day you are available to work (please note that most positions require weekend availability)*

Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday

Type of employment desired (check all that apply)*

Full-time
Part-time
Temporary
Summer Only

Are you willing to work (check all that apply)*

Days (7a-4p)
Evenings (4p-11p)
Nights (11p-7a)
Overtime
Holidays

Is there any time that you cannot work?

EMPLOYMENT HISTORY

Provide the following information for your past four (4) employers, assignments, or volunteer activities, starting with the most recent.

From*

To*

Company*

Phone*

Address*

Street City State ZIP Code

Job Title*

Supervisor*

Summarize the Nature of Work Performed and Job Responsibilities:*

Reason for Leaving:*

Starting Wage*

Per*

Ending Wage*

Per*

From*

To*

Company*

Phone*

Address*

Street City State ZIP Code

Job Title*

Supervisor*

Summarize the Nature of Work Performed and Job Responsibilities:*

Reason for Leaving:*

Starting Wage*

Per*

Ending Wage*

Per*

From*

To*

Company*

Phone*

Address*

Street City State ZIP Code

Job Title*

Supervisor*

Summarize the Nature of Work Performed and Job Responsibilities:*

Reason for Leaving:*

Starting Wage*

Per*

Ending Wage*

Per*

From*

To*

Company*

Phone*

Address*

Street City State ZIP Code

Job Title*

Supervisor*

Summarize the Nature of Work Performed and Job Responsibilities:*

Reason for Leaving:*

Starting Wage*

Per*

Ending Wage*

Per*

SKILLS & QUALIFICATIONS

Summarize any training, skills, licenses, relevant work experience, and/or certificates that may qualify you as being able to perform job-related functions in the position for which you are applying:

EDUCATION

High School*

Address*

Street City State ZIP Code

Years Completed*

Did you graduate?*

Yes
No

College

Address

Street City State ZIP Code

Years Completed

Did you graduate?

Yes
No

Degree

Other

Address

Street City State ZIP Code

Years Completed

Did you graduate?

Yes
No

Degree

REFERENCES

Provide the following information for three (3) references:

Name*

First Last

Phone*

Occupation*

Years Known*

Name*

First Last

Phone*

Occupation*

Years Known*

Name*

First Last

Phone*

Occupation*

Years Known*

APPLICANT INFORMATION*

I agree to the terms and conditions.

I understand that if I am employed, any misrepresentation or material omission made by me on this application will be
sufficient cause for cancellation of this application or immediate discharge from the employer's service, whenever it is
discovered.

I give the employer the right to contact and obtain information from all references, employers, educational institutions, and
to otherwise verify the accuracy of the information contained in this application. I hereby release from liability the
employer and its representatives for seeking, gathering, and using such information and all other persons, corporations, or
organizations for furnishing such information.

The employer does not unlawfully discriminate in employment and no question on this application is used for the purpose
of limiting or excusing any applicant from 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.

If I am hired, I understand that I am free to resign at any time, with or without cause and without prior notice, and the
employer reserves the same right to terminate my employment at any time, with or without prior notice, except as may be
required by law. This application does not constitute an agreement or contract for employment for any specified period or
definite duration.

I understand that no representative of the employer, other than an authorized officer, has the authority to make any
assurances to the contrary. I further understand that any such assurances must be in writing and signed by an authorized
officer.

I understand it is this company's policy not to refuse to hire a qualified individual with a disability because of that person's
need for a reasonable accommodation as required by the A.D.A.

I also understand that if I am hired, I will be required to provide proof or identity and legal work authorization.

I represent and warrant that I have read and fully understand the foregoing and seek employment under these conditions.

Phone

This field is for validation purposes and should be left unchanged.

APPLICATION FOR EMPLOYMENT

GENERAL INFORMATION

Please read the ‘Notice to Prospective Applicants’ before applying.

JOB INTEREST

EMPLOYMENT HISTORY

SKILLS & QUALIFICATIONS

EDUCATION

REFERENCES