EMPLOYMENT APPLICATION

Position Applied For:
Name
Today's Date:
Address:
Phone Number: *
Email: *
(Check one)
Are there any days, shifts, or hours you will not work? If yes, please explain:
If under 18 years of age, please specify your age: (Under the Fair Labor Standards Act, this information will be used only for child labor law purposes.)
When are you able to start work?
Will you work overtime?
How did you learn of our company?
Have you ever applied or worked for BCC? If so, when?
Are you legally authorized to work in the United States?
Will you now or in the future require sponsorship for employment visa status? (ie.H-1B visa status)
Do you have a valid driver's license?
State:
License No.
Have you had any tickets in the past 7 years? Please explain:
Has your license ever been suspended or revoked?
Do you have any DUI or DWI convictions? Please explain:
Company
Address
Phone Number *
Supervisor:
May we contact?
Job Title:
Dates Employed:
Responsibilities:
Rate of Pay:
Reason for Leaving:
Company
Address
Phone Number *
Supervisor:
May we contact?
Job Title:
Dates Employed:
Responsibilities:
Rate of Pay:
Reason for Leaving:
Company
Address
Phone Number *
Supervisor:
May we contact?
Job Title:
Dates Employed:
Responsibilities:
Rate of Pay:
Reason for Leaving:
Name
Phone *
Relationship
Company (if applicable)
Name
Phone *
Relationship
Company (if applicable)
Name
Phone *
Relationship
Company (if applicable)
Name of Educational Institution
Graduated?
Credits Earned
Type of Degree/Major/Minor
GPA
Name of Educational Institution
Graduated?
Credits Earned
Type of Degree/Major/Minor
GPA
Name of Educational Institution
Graduated?
Credits Earned
Type of Degree/Major/Minor
GPA
Name of Educational Institution
Graduated?
Credits Earned
Type of Degree/Major/Minor
GPA
Name of Educational Institution
Graduated?
Credits Earned
Type of Degree/Major/Minor
GPA
Branch of Service:
Number of Years/Months of Service:
Rank at Discharge:
Date of Discharge:
Reason for Leaving:
Describe any military skills, training, or experience you believe are relevant:
Have you been convicted within the last 7 years of a felony?
Date of Conviction:
Have you been convicted within the last 7 years of misappropriation of funds, embezzlement, or similar for other dishonest conduct; or an offense involving the use of a weapon; for burglary, robbery, breaking and entering, or theft; or physical assault or other violent crime?
Have you been convicted of or completed a period of incarceration within the past 5 years for any misdemeanor?
Additionally if yes, please state whether you were convicted more than 5 years ago for any offense:
A criminal conviction will not necessarily be a bar to employment. To help us evaluate your application, please describe your criminal conviction(s) including penalty(ies) imposed, listing the nature of your offense(s), and your rehabilitation since the conviction(s).
Have you taken any illegal drugs in the last 30 days?
Have you ever been a defendant in a civil action for an intentional tort (intentional commission of a wrongful act)? Note: Answering "Yes" does not automatically exclude you from further consideration. If yes, include nature of the intentional tort and the disposition of the action:
Signature (please sign your full name)
Date
Signature (please sign your full name)
Date
I Agree