Employment Application

An Equal Opportunity Employer - All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability status, protected veteran status, or any other characteristic protected by law.

Personal Information

Name*

First Middle Last

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Email

Phone*

Are you eligible to work in the U.S?*

Yes
No

Are you at least 16 years or older?*

Yes
No

Have you ever been terminated from employment or asked to resign by an employer?*

Yes
No

Please provide company name and details*

Please select shifts you are available to work (select all that apply)*

Day
Evening
Nights
Weekends

Can you work overtime if needed, including weekends?*

Yes
No

Are you able to perform the essential functions of the job for which you are applying, with or without reasonable accommodation?*

Yes
No

Employment Desired

Position Desired*

Date you can start

Are you currently employed?*

Yes
No

May we inquire of your present employer?*

Referral Source

How did you hear about us?*

Walk-In
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Referral

Have you ever worked for this company before?*

Yes
No

Please Explain*

Do you know anyone who works for our company?*

Yes
No

Who?*

Education*

Level(High School, College, Other)	Name of School, City & State	Course of Study / Degree Earned	Number of completed years	Did you Graduate

Employment History*

Include your last seven (7) years of employment history, including periods of unemployment, starting with the most recent and working backwards in time. Incomplete information could disqualify you from further consideration.

Employer Name	Address, City, State	Phone	Job Title	Date From	Date To	Starting Salary/Wages	Ending Salary/Wages	Immediate Supervisor and Title	Summarize nature of work and responsibilities	May we contact this employer Y/N?	Do you have any special skills, experience and/or training, or licensing that would enhance your ability to perform the position applied for? If yes, explain.

References*

Give the names of three persons not related to you, whom you have known at least three (3) years.

Name	Address, Phone, Email	Company	Years Acquainted

Application Upload

Accepted file types: doc, docx, rtf, txt, pdf, jpg, png, gif, Max. file size: 64 MB.

AUTHORIZATION & CERTIFICATION*

I agree to the below

Aicota is an equal opportunity employer. Aicota does not discriminate in employment on account of race, color, religion, national origin, citizenship status, ancestry, age, sex (including sexual harassment), sexual orientation, marital status, physical or mental disability, military status or unfavorable discharge from military service.
I understand that neither the completion of this application nor any other part of my consideration for employment establishes any obligation for Aicota to hire me. If I am hired, I understand that either Aicota or I can terminate my employment at any time and for any reason, with or without cause and without prior notice. I understand that no representative of Aicota has the authority to make any assurance to the contrary.
I attest with my signature below that I have given to Aicota true and complete information on this application. No requested information has been concealed. I authorize Aicota to contact references provided for employment reference checks. If any information I have provided is untrue, or if I have concealed material information, I understand that this will constitute cause for the denial of employment or immediate dismissal.

THIS APPLICATION IS VALID ONLY FOR 60 DAYS FROM THE DATE SUBMITTED

Comments

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Application For Employment

Personal Information

Employment Desired

Referral Source