PERSONAL INFORMATION

First Name

Middle Name

Last Name

Date of Application

Email Address

Phone Number

POSITION / AVAILABILITY

Date Available

Desired Pay

Pay Type:

Hourly

Salary

Position Applied For:

Employment Desired:

Full Time

Part Time

Shift(s) Available to Work:

Days

Afternoons

Midnights

Shift(s) Preferred:

Days

Afternoons

Midnights

Have you ever worked for Varflex Corporation before?

Yes

No

Start Date

End Date

Have you ever applied to work for Varflex Corporation before?

Yes

No

If so, when:

Do you have friends, relatives, or acquaintances working for Varflex?

Yes

No

If so, who:

Do you have a driver's license?

Yes

No

If no, do you have reliable transportation?

Yes

No

If hired, are you willing to submit to & pass a drug test?

Yes

No

Are you able to perform the essential functions of the job for which you are applying, either with/without reasonable accomodation?

Yes

No

If not, describe the functions that cannot be performed

Note: Varflex Corporation complies with the ADA and considers reasonable accommodation measures that may be necessary for eligible applicants/employees to perform essential functions. It is possible that a hire may be tested on skill/agility and may be subject to a medical examination conducted by a medical professional

Have you ever been convicted of a felony or misdemeanor?

Yes

No

If yes, please describe the crime - state the nature of the crime(s), when and where convicted, and disposition of case:

Note: No applicant will be denied employment solely on the grounds of conviction of a criminal offence. The date of the offense, the nature of the offense, including any significant details that affect the description of the event, and the surrounding circumstances and the relevance of the offense to the position(s) applied for, may, however, be considered.

EDUCATION

High School:

City/State:

Did you graduate?

Yes

No

Diploma Earned:

College/University 1

City/State:

Years Completed:

Did you graduate?

Yes

No

Diploma Earned:

Special Skills & Qualifications:

MILITARY SERVICE

Are you a veteran?

Yes

No

Branch:

Rank at Discharge:

Years of Service:

EMPLOYMENT HISTORY

Note: Please describe past & present employment positions. Please account for all years of employment. Even if you attached a resume, this section must be completed.

Are you currently employed?

Yes

No

May we contact this employer?

Yes

No

EMPLOYER 1:

Company / Individual

Supervisor:

Phone

Company / Individual Address

Job Title

Start Date

End Date

Reason for Leaving

Duties

EMPLOYER 2:

Company / Individual

Supervisor:

Phone

Company / Individual Address

Job Title

Start Date

End Date

Reason for Leaving

Duties

REFERENCES
(PROFESSIONAL ONLY)

Reference #1:

Reference #2:

Reference #3:

EEO-1 VOLUNTARY SELF IDENTIFICATION FORM

The Equal Employment Opportunity Commission (EEOC) requires all private employers with 100 or more employees as well as federal employees and first tier subcontractors with 50 or more employees AND contracts of at least $50,000 complete and EEO-1 report each year. Covered employers must invite employees to self-identify gender and race for this report.

Completion of this form is voluntary and will not affect your opportunity for employment, or the terms or conditions of your employment. This form will be used for EEO-1 reporting purposes only and will be kept separate from all other personnel records only accessed by the Human Resources Department. Please complete this form for submission to HR Department.

If you choose not to self-identify your race/ethnicity at this time, the federal government requires Varflex Corporation to determine this information by visual survey and/or other available information.

First and Last Name

Date

RACE/ETHNICITY: (Please check one of the descriptions below corresponding to the ethnic group with which you identify.)

Hispanic or Latino: A person of Cuban, Mexican, Puerto Rican, South or Central American, or other Spanish culture or origin regardless of race.

White (Not Hispanic or Latino): A person having origins in any of the original peoples of Europe, the Middle East or North Africa.

Black or African American (Not Hispanic or Latino): A person having origins in any of the black racial groups of Africa.

Native Hawaiian or Pacific Islander (Not Hispanic or Latino): A person having origins in any of the peoples of Hawaii, Guam, Samoa or other Pacific Islands.

Asian (Not Hispanic or Latino): A person having origins in any of the original peoples of the Far East, Southeast Asia or the Indian Subcontinent, including, for example, Cambodia, China, India, Japan, Korea, Malaysia, Pakistan, the Philippine Islands, Thailand and Vietnam.

Native American or Alaska Native (Not Hispanic or Latino): A person having origins in any of the original peoples of North and South America (including Central America) and who maintains tribal affiliation or community attachment.

Two or more races (Not Hispanic or Latino): All persons who identify with more than one of the above five races.

I do not wish to disclose.

ACKNOWLEDGEMENTS

Please Read and Initial Each Paragraph, then Sign Below

I certify that I have not purposely withheld any information that might adversely affect my chances for hiring. I attest to the facts that the answers given by me are true & correct to the best of my knowledge and ability. I understand that any omissions (including any misstatement) of material fact on this application or on any document used to secure can be grounds for rejection of application or, if I am employed by this company, terms for my immediate expulsion from this company.

Initials

I understand that if I am employed, my employment is not definite and can be terminated at any time either with or without prior notice, and by either me or the company.

Initials

I permit the company to examine my references, record of employment, education record, and any other information I have provided. I authorize the references I have listed to disclose any information related to my work record and my professional experiences with the, without giving me prior notice of such disclosure. In addition, I release the company, my former employers & other persons, corporations, partnerships & associations from any & all claims, demands or liabilities arising out of or in any way related to such examination or revelation.

Initials

Your Signature

Date

Please attach a resume if you have one available. Thank you for applying with us! We will get in touch with you shortly.

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EMPLOYMENT / JOB APPLICATION

PERSONAL INFORMATION

POSITION / AVAILABILITY

EDUCATION

MILITARY SERVICE

EMPLOYMENT HISTORY

EMPLOYER 1:

EMPLOYER 2:

REFERENCES
(PROFESSIONAL ONLY)

EEO-1 VOLUNTARY SELF IDENTIFICATION FORM

ACKNOWLEDGEMENTS

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EMPLOYMENT / JOB APPLICATION

PERSONAL INFORMATION

POSITION / AVAILABILITY

EDUCATION

MILITARY SERVICE

EMPLOYMENT HISTORY

EMPLOYER 1:

EMPLOYER 2:

REFERENCES (PROFESSIONAL ONLY)

EEO-1 VOLUNTARY SELF IDENTIFICATION FORM

ACKNOWLEDGEMENTS

REFERENCES
(PROFESSIONAL ONLY)