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head-work

Items marked with an asterisk (*) are required

If you have problems completing or submitting this form, please email info [at] peaktoplains.com.

Full Name*
Email Address*
Phone
Desired Pay $
Availability - Hours
Hours & Days
Availability - Time
Positions applied for (check all that apply)
 Retail Sales / Stocking / Cashier / Mgmt Meat Processing Driver / Warehouse Accounting / Administration
State the number of pounds you are capable of lifting in the work environment.
When are you available to start work?

If hired, do you have transportation to work? yes no 

Work history (Please list up to three previous jobs)

Previous Employer

Name
Employment
(From mm/yy to mm/yy)
Address
Phone
Supervisor
Salary $

List the jobs you held, duties performed, skills used or learned, advancements, or promotions while you worked at this company

May we contact your employer
 yes no

Previous job 2

Name
Employment
(From mm/yy to mm/yy)
Address
Phone
Supervisor
Salary $

List the jobs you held, duties performed, skills used or learned, advancements, or promotions while you worked at this company

May we contact your employer
 yes no

Previous job 3

Name
Employment
(From mm/yy to mm/yy)
Address
Phone
Supervisor
Salary $

List the jobs you held, duties performed, skills used or learned, advancements, or promotions while you worked at this company

May we contact your employer
 yes no
Education

High School
Dates
Year Graduated

College
Concentration
Dates
Year Graduated

Other

Skills

Typing

Computer PC Macintosh Both 

Applications (list)

List other skills

References

Please list two references other than relatives or previous employers

Name
Relationship
Company
Telephone


Name
Relationship
Company
Telephone

Have you ever been convicted of a misdemeanor or felony? yes no 

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

NOTE: No applicant will be denied employment solely on the grounds of conviction of a criminal offense. 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.

Are you 18 years or age or older? yes no 

If under 18, hire is subject to verification of minimum legal age

If hired, would you be able to present evidence of your US citizenship or proof of your legal right to work in the United States?
yes no 

If hired, are you willing to submit to and pass a controlled substance test?
yes no 

Are you able to perform the essential functions of the job for which you are applying either with/without reasonable accommodation?
yes no 

If no, describe the functions which cannot be performed

Note: Company 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 skills/agility and may be subject to a medical examination conducted by a medical professional.

Have you had any traffic accidents in the past three years? yes no  If yes, how many and please explain?

Have you had any moving violations in the past 3 years? yes no  If yes, how many and please explain?

Driver's license number

Type of Driver's license

State of issue

I CERTIFY THAT INFORMATION CONTAINED IN THIS APPLICATION IS TRUE AND COMPLETE. I UNDERSTAND THAT FALSE INFORMATION MAY BE GROUNDS FOR NOT HIRING ME OR FOR IMMEDIATE TERMINATION OF EMPLOYMENT AT ANY POINT IN THE FUTURE IF I AM HIRED. I AUTHORIZE THE VERIFICATION OF ANY OR ALL INFORMATION LISTED ABOVE.

yes no 

PLEASE GIVE ANY FURTHER INFORMATION WHICH MAY BE HELPFUL TO US IN CONSIDERING YOUR QUALIFICATIONS