Employment Application Application For Employment with Blatt & Tillett Thank you for your interest in our organization. Our company is an equal opportunity employer and complies with all applicable federal, state, and local employment laws. The following information is required for employment consideration and does not constitute a contract or offer of employment.Personal InformationFull Name* First Middle Last Date of Birth*Drivers License Number*Address* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Phone Number*Email Address* Position for which you are applying* Operations/ Administrative Technician Operator Other Desired salary or hourly wageAre you authorized to work in the U.S.?* Yes No Are you at least 18 years old?* Yes No Can you perform the essential functions of the position to which you are applying?* Yes No Can you lift 50 lbs. on a regular basis?* Yes No Employment AvailabilityHow soon are you available for work?What type of employment are you applying for?*(Click all that apply.) Full Time Part Time 1st Shift 2nd Shift 3rd Shift Can you work overtime?* Yes No Education/TrainingName of the high school you attended?Did you graduate? Yes No College/ technical school attended?Subject studied?Did you graduate? Yes No Did you serve in the Military? Yes No Special Qualifications or SkillsUse this space to describe any special qualifications or skills you have acquired.Employment History(Three employers are required. List present or most recent employer first.)Employer*Employer Phone*Position*Start date (Month/Year)*Starting Salary*Final date (Month/Year)*Ending Salary*Duties*Reason for leaving?*May we contact employer?* Yes No Employer 2*Employer 2 Phone*Position at employer 2*Immediate Supervisor at employer 2*Start date (Month/Year)*Starting Salary at Employer 2*Final date (Month/Year)*Ending Salary at Employer 2*Duties at employer 2*Reason for leaving employer 2?*May we contact employer 2?* Yes No Employer 3*Employer 3 Phone*Position at employer 3*Immediate Supervisor at employer 3*Start date (Month/Year)*Starting Salary at Employer 3*Final date (Month/Year)*Ending Salary at Employer 3*Duties at employer 3*Reason for leaving employer 3?*May we contact employer 3?* Yes No Applicant's StatementConsent*Please recheck this application for accuracy and read this statement carefully before signing below. I acknowledge that the answers provided are true and accurate to the best of my knowledge. If offered employment by the company, I agree to conform to all rules and regulations of the Company, which I recognize may be changed without prior notice. I hereby consent to the inspection at any time by Company officials of any property in my possession on Company premises and consent to any physical tests upon the request of a Company official at Company expense to reveal the presence of alcohol or drugs in my system. I understand that failure to submit to such tests will result in immediate termination of employment. I understand if I am accepted for employment by the Company, my employment will not result in or be subject to a contract of employment. I recognize and agree if I am employed, employment may be terminated at any time by the employee or the Company, with or without notice, with or without cause. I further understand no supervisor or other official of the Company has any authority to enter into any agreement with me for employment for any specified period of time or to make any agreement contrary to the foregoing. By checking the box, I agree to the statements above.Signature of Applicant*Untitled First Choice Second Choice Third Choice Untitled First Choice Second Choice Third Choice X/TwitterThis field is for validation purposes and should be left unchanged.
