APPLICATION FOR EMPLOYMENT

Applicants are considered for all positions, and employees are treated without regard to age, race, color, religion, sex, national origin, ancestry, military or veteran status, disability, sexual orientation, or any other prohibited basis of discrimination, as provided under applicable state and federal law.

Step 1 of 6

Personal Information
Name*
First Middle Last
Address*
Street Address Address Line 2 City State ZIP Code
Home Phone*
Cell Phone*
Email address*
Position
Position(s) applied for:*
Position Type*
- Full-time
- Part-time
- Summer
Desired Rate of Pay*
How did you hear about us?*
- Advertisement
- Relative
- Employment agency
- Walk-in
- Friend
- Other
Please specify how you heard about us
Please list any VENO'S employees who are friends or relatives of yours.
Name
Relationship
Name
Relationship

Personal Information (continued)
Are you at least 18 years old?*
- Yes
- No
Do you hold a valid driver’s license?*
- Yes
- No
What state?*
License Number?*
Are you able to become lawfully employed in this country?*
Proof of citizenship or immigration status will be required upon employment.
- Yes
- No
Have you ever been convicted of any violation of law by any court of law?*
- Yes
- No
Include any guilty pleas entered, military courts martial, traffic violation convictions for Operating Under the Influence (OUI), or traffic violations that resulted in your license being suspended. Do not include any conviction(s) occurring before your 18th birthday or traffic violations not listed above.
Offense(s)*
Location*
Date of Conviction(s)*
MM slash DD slash YYYY
Offense(s)
Location
Date of Conviction(s)
MM slash DD slash YYYY
Offense(s)
Location
Date of Conviction(s)
MM slash DD slash YYYY
Offense(s)
Location
Date of Conviction(s)
MM slash DD slash YYYY
Not all conviction(s) will automatically disqualify you from employment but will be considered in relation to specific job requirements. Omission or misrepresentation of this information may result in employment ineligibility.

References
Name*
First Last
Phone*
Address*
Address City State
Name*
First Last
Phone*
Address*
Address City State

Employment History
Are you currently employed?*
- Yes
- No
May we contact your current employer for a reference?*
- Yes
- No
Current or Last Employer
Company
Phone Number
Address
Address City State
Supervisor's name
Position
Date hired
Date left
Duties
Reason for leaving
Rate of pay
Previous Employer
Company
Phone Number
Address
Address City State
Supervisor's name
Position
Date hired
Date left
Duties
Reason for leaving
Rate of pay
Previous Employer
Company
Phone Number
Address
Address City State
Supervisor's name
Position
Date hired
Date left
Duties
Reason for leaving
Rate of pay

Education History
Name of High School*
Graduated?*
- Yes
- No
Address*
Street Address City State
GED?*
- Yes
- No
Name of College/University
Graduated?
- Yes
- No
Address
Street Address City State
Other
Graduated?
- Yes
- No
Address
Street Address City State
Military Experience?
Branch
Special Training

Applicant’s Statement
These answers are true and complete to the best of my knowledge. Veno's may investigate all statements contained in this application, and I understand any false or misleading information provided may result in my immediate discharge, if hired. I UNDERSTAND THAT THIS APPLICATION IS NOT A CONTRACT OF EMPLOYMENT AND THAT IF HIRED, REGARDLESS OF ANY ORAL REPRESENTATIONS TO THE CONTRARY, THE EMPLOYMENT RELATIONSHIP BETWEEN MYSELF AND VENO'S IS TERMINABLE-AT-WILL. ANY CHANGES IN THIS EMPLOYMENT RELATIONSHIP MUST BE MADE IN WRITING.
Signature of Applicant*
In connection with my application for employment, I understand and agree that background inquiries may be requested by you or on your behalf that will seek information as to my character, work habits, including oral assessments of my job performance, experiences and abilities, along with reasons for termination of past employment. Furthermore, I understand and agree that you may request information from various federal, state, and other agencies, including public and private sources which maintain records concerning my past activities relating to my criminal record, civil matters, previous employment, educational background, and other past experiences.

I acknowledge that a telephonic facsimile or copy of this release shall be as valid as the original. This release is valid for all federal, state, county and local agencies and authorities.

The following is my complete and legal name, and all information is true and correct to the best of my knowledge.
Name*
First Middle Last
Signature of Applicant*
Date of Birth
(Optional - used for background check, only)
MM slash DD slash YYYY
Current Address*
Street Address Address Line 2 City State ZIP Code
Years*
Previous Address
Street Address Address Line 2 City State ZIP Code
Years
Previous Address
Street Address Address Line 2 City State ZIP Code
Years
Previous Address
Street Address Address Line 2 City State ZIP Code
Years

APPLICATION FOR EMPLOYMENT

Step 1 of 6

Personal Information

Position

Personal Information (continued)

References

Employment History

Current or Last Employer

Previous Employer

Previous Employer

Education History

Military Experience?

Applicant’s Statement