Southwind Employment Application (copy) (copy)

Employment Application

Full Name *

Email Address *

example@example.com

Phone Number *

Current Address *

Job Information

Were you referred by a current or past employee? *

If yes, please provide the referral full name: *

Available Start Date *

Type of Employment: *

Are you at least 21 years of age? *

Are you authorized to work in the United States? *

*(If offered employment, you will be required to provide documentation to verify eligibility.)

Do you have a valid drivers license? *

Drivers License Number: *

Are any of your records under a different name? *

If yes, what name: *

If yes, please explain: *

Are you able to perform the essential job functions of the position you are applying for with or without reasonable accommodations? *

Note: We comply with the ADA and consider reasonable accommodation measures that may be necessary for qualified applicants/employees to perform essential job functions.

Education and Past Employment

List any certifications or training experiences that you've had:

List any skills or abilities you have which are relevant to the position, including hobbies or related interests:

May we contact past employers? *

I have had previous employment. *

1. Present or Last Employer *

Start Date *

Leaving Date *

Supervisor *

Email or Phone Number *

Job Title *

Reason for Leaving *

2. Previous Employer

Start Date

Leaving Date

Supervisor

Email or Phone Number

Job Title

Reason for leaving

Personal References

1. Name *

Phone Number *

Relationship *

How Long Known: *

2. Name

Phone Number

Relationship

How Long Known:

Please Attach Documents

Drivers License *

Social Security Card *

*Southwind and its group of companies is an equal opportunity, affirmative action, veteran friendly employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, or national origin. By completing this form I authorize and willingly submit personal information and understand that all information collected will be utilized for purposes of employment only. This may include completion of the I-9 verification process and I must provide proof of my identity and eligibility for employment within three days of beginning to work. Failure to complete this request may result in separation of employment. It is understood that this information is protected and confidential. I also understand that employees obtaining this information are governed by a non-disclosure agreement. If I have any questions regarding the collection of information or its intended purposes I may always contact a member of Human Resources.

PLEASE READ EACH OF THE FOLLOWING ITEMS BEFORE SIGNING THIS APPLICATION

1. I CERTIFY that the facts contained in this application are true and complete, and understand that if employed, false, misleading or incomplete statements on this application shall be grounds for immediate dismissal. 2. I AUTHORIZE the company to investigate and verify any information contained in my application or pre-hire interviews, including my previous employment, education and background. I further release all parties from all liability for any damage that may result from furnishing or receiving such information. I authorize a background check to be completed by Southwind Services at their discretion. 3. I UNDERSTAND and agree that my employment and compensation may be terminated at any time without prior notice, with or without reason, at the option of the company or myself, and understand that no representative of the company, other than the President or other Officer in writing, has authority to enter into any agreement contrary to the foregoing. 4. I UNDERSTAND that all company property must be returned and any indebtedness to the company must be paid on or before my last day of work. I authorize the company to deduct from my final paycheck an amount necessary to satisfy any unpaid obligation.

Today's Date *

Signature *

Name *