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Application for Employment

BEVCOMM is an Equal Opportunity Employer.  No question on this form is asked for the purpose of limiting or excluding any applicant’s consideration because of protected status.
Legal Name – First
Middle Initial
Last
Address - Street
City
State
ZIP Code
Phone Number
Alternate No.
Email Address
Are you at least 16 years of age?
Yes
No
Are you a U.S. Citizen or national, permanent resident, a refugee, an asylee, or authorized to work under the amnesty provisions of U. S. immigrant law?
Yes
No

Sourcing

How did you find out about this position?
Friend/Relative (specify source)
Job Fair (specify source)
 BEVCOMM Employee (specify source)
Web Site (specify source)
Newspaper Advertisement (specify source)
Other (specify source)
Source:
Have you ever applied for a position with BEVCOMM?
Yes
No
If yes, when?: (MM/DD/YY)
Have you ever worked at BEVCOMM before?
Yes
No

Work Interests

 If yes, when and what position?
Position(s) to which you are applying
Date available for employment
Availability (please check all that apply):
Full-time
On-call
Weekend
Day
Part-time
Night
Summer Only
Overtime
Number of desired hours per week:
Salary Expectation:

References

Please list three work and/or education related references.  Do not list relatives.

Name
Phone number
Address
Relationship
Name
Phone number
Address
Relationship
Name
Phone number
Address
Relationship

Education

Do you have a high school diploma or GED?
Yes
No
If yes, please provide name and location of high school or GED program:

In the spaces below, please list any additional schools beyond high school/GED that you have attended, number of years completed, degrees received and your primary area of study.

School/City/State
Years Completed
Expected Completion
Degree Received
Course of Study (major/minor)
School/City/State
Years Completed
Expected Completion
Degree Received
Course of Study (major/minor)
School/City/State
Years Completed
Expected Completion
Degree Received
Course of Study (major/minor)

Work History

Please provide your work history starting with present or most recent employer, include military service, if applicable.  You may attach an additional page if you have additional relevant work history.

Employer 1

Name of Employer
Start Date
End Date
City
State
Zip Code
Job Title
Name of Supervisor
Title of Supervisor
Salary - Beginning
Salary - End
Phone number
May we contact this employer?
Yes
No
Yes, at a later date
Job Duties

Employer 2

Reason for Leaving
Name of Employer
Start Date
End Date
City
State
Zip Code
Job Title
Name of Supervisor
Title of Supervisor
Salary - Beginning
Salary - End
Phone number
May we contact this employer?
Yes
No
Yes, at a later date
Job Duties
Reason for Leaving

Employer 3

Name of Employer
Start Date
End Date
City
State
Zip Code
Job Title
Name of Supervisor
Title of Supervisor
Salary - Beginning
Salary - End
Phone number
May we contact this employer?
Yes
No
Yes, at a later date
Job Duties
Reason for Leaving

Employer 4

Name of Employer
Start Date
End Date
City
State
Zip Code
Job Title
Name of Supervisor
Title of Supervisor
Salary - Beginning
Salary - End
Phone number
May we contact this employer?
Yes
No
Yes, at a later date
Job Duties
Reason for Leaving

Other Qualifications

Please list other jobs, skills, training courses, membership, etc. relevant to this position.
Please list MS Office experience.
Do you have a current Commercial Driver’s License (CDL)?
Yes
No
If yes, in what state(s)?
Expiration Date(s)?

Please read carefully and sign below.
I affirm that all information contained in this application is true and complete and that any misrepresentation, falsification, or willful omission herein shall be sufficient reason for dismissal and/or refusal of employment.  I understand that employment is subject to satisfactory reference reports, satisfactory completion of a post-offer/pre-employment background check, satisfactory completion of a post-offer/pre-employment medical examination (will include drug-screen), proof of identity and authorization to work in the United States.
I understand that all conditions of employment, including but not limited to hours, benefits, and salary are subject to change by BEVCOMM at any time without prior notice to employees.  I also understand that employment at BEVCOMM is “at will” employment and may be terminated at any time by either party.  BEVCOMM reserves the right to decide in its sole discretion whether it will assist any foreign national to obtain or extend any necessary work authorization under U.S. immigration law, and whether to revoke an offer of employment to such person.  I further understand that I am required to abide by all rules and regulations of BEVCOMM.

I certify the information provided above is true and complete to the best of my knowledge.  I have read and understand the statements in the paragraphs above.  By signing here, I am also verifying all information on my resume. 

Signature
Date of Signature
Submit