APPLICATION FOR EMPLOYMENT
VARIOUS FEDERAL, STATE, AND LOCAL LAWS PROHIBIT DISCRIMINATION BASED ON RACE, COLOR, SEX, SEXUAL ORIENTATION, RELIGION, CREED. NATIONAL ORIGIN, ANCESTRY, AGE, PHYSICAL OR MENTAL DISABILITY, PREGNANCY, MEDICAL CONDITION, CITIZENSHIP, MILITARY SERVICE STATUS, VETERAN STATUS, OR MARITAL
STATUS. Robeks Juice IS AN EQUAL OPPORTUNITY EMPLOYER AND YOUR RESPONSE TO ANY QUESTION WILL NOT BE USED AS A BASIS FOR DISCRIMINATION, BUT WILL
BE JUDGED ON ITS RELEVANCE TO THE POSITION YOU ARE SEEKING.
PERSONAL INFORMATION:
Name |
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Social Security Number |
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Middle Initial |
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Address |
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Street |
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City |
State |
Zip |
Home Phone Number ( |
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Cell Phone Number ( |
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Are you at least 16 years of age? |
YES |
ONO (Employees under the age of 18 may be required to obtain a work permit) |
How did you hear about the position?
Have you ever been employed by or applied for a position with any ROBEKS locations? |
LJYES |
QNO |
If yes, please list dates and location(s)
Are you able, upon employment, to submit verification of your identity and legal right to work in the United States? QYES [Z]NO
Identity and employment eligibility of all new hires will be verified as required by the Immigration Reform and Control Act of 1986.
Have you ever been convicted of a crime?
PLEASE REVIEW SPECIAL NOTICE REGARDING CRIMINAL CONVICTIONS BEFORE RESPONDING TO THIS QUESTION. |
DYES [JNO |
If you answered “yes,” please explain and include the date(s), court(s), nature of offense(s), and dispositions(s).
NOTICE TO APPLICANTS IN CALIFORNIA - In responding to the question concerning criminal convictions, you should not report (in other words, you should not answer “yes”) with respect to any of the following: (a) minor traffic violations, (b) marijuana-related convictions dated more than two years ago, (c) convictions that have been judicially ordered sealed, expunged, or statutorily eradicated, or (d) misdemeanor convictions which have been judicially dismissed pursuant to California Penal Code Section 1203.4. You also should not provide any information concerning a referral to, and participation in, any pre-trial or post-trial diversion program. You will not necessarily be disqualified for employment because of an affirmative answer.
EMPLOYMENT DESIRED:
Position: |
^ASSOCIATE |
DSHIFT LEADER |
[^MANAGER |
When are you available to start work? |
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Total available Hours per week: |
Hours |
Are you willing to work at other ROBEKS locations? ОYES |
CZJNO |
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Please indicate the hours you are available to work. |
MON |
TUES |
WED |
THUR |
FRI |
SAT |
SUN |
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FROM |
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EDUCATION: |
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Name & location of school |
Level completed |
Degree |
Course/ Major |
High School |
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College or Other Training
REFERENCES: (give the names of three individuals not related to you whom you have known at least one year)
Name |
Address |
Phone |
Years Acquainted |
1.
2.
3.
In Case of Emergency, contact: |
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Phone ( |
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t.'Crigln
Rev’osi»
gWPlflУ:
(Start with your олгепіогпк^ recent employer i is* all emptoycra tar "he lass Len years. Please anach addrtianal sheets i( necessary.!
Dale |
Employer п-ягпе are? address |
Роейоп |
Stan |
End |
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FinaS Wage |
___ Й____ |
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Supemsor |
Reason (or leaving |
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Phone Number |
Date |
Employe* п-эте and address |
Poston |
Start |
End |
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Final Wage |
to |
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Supeiwx |
Resson fcr teavng |
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Prons hniroer |
Date |
Employe? п яте and address |
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Start |
End |
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Final Wage |
to |
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Зсреллдаг |
Reason for teavtog |
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Phone Nusvber |
^TKMML JNFOfiJWATOK-
Fsease indude any other nformatkM you tonk ашИ be helpful to us -o cansidMing you Гог empioymeft", sodi as babbies, intetess, additkxal wortc
experience. iwnas woewed, ^unteetwork. organttawns or groups, ей. ^You йвд&пй afllmfofmaboft lhai would mdstateage, sei, sexual mentsflton. гада, поддалL соку. гкайэп&і cngin or disabity).
VOtMWfr:
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Ptease <4* |
iM wcwxi is ѵЛічэгу. it is not педаздагу to compete ard ™й |
bt МУ ageist any afttoni *i cons+derafion nor а pc^ficn with ^otte*?. |
Please awr 2 of the 5 АЫШring qiKsiim, it «os$s#y please use a $до#е sheet oi paper |
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tore one person. pte»b <и 1ling fei inspires yous and ieil ws why^._______________________________________________________________ |
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if yfrj were a fruit i^tal fruit woukf you be and wliy? |
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3. |
йагпе ^ регкип^эколгірі^тегіГ'ри аге лгк>5і ртай oP _ |
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4. |
Wharf rnakes you уrsquit from anybodyrelse applying adfiabeks Juice?_____________ _____ |
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5. |
Wiert s your febrile fiw. TV show, or book and why?_______________________________________________________________________ _ |
APPLiCANr^TEME^
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Date____________________________________ Signatare