NAME

First Name

Last Name

ADDRESS

CITY, STATE, ZIP

POSITION DESIRED

DATE AVAILABLE TO START

YYYY

TELEPHONE NUMBER

Unreturned calls will be considered withdrawl of application for employment. Please enable Voicemail on phone.

(###)

###

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DRIVER'S LICENSE

HOW WERE YOU REFERRED TO THIS FACILITY?

HAVE YOU EVER WORKED FOR THIS COMPANY? IF YES, WHEN?

DESIRED STATUS

FULL-TIME

PART-TIME

HAVE YOU EVER APPLIED TO THIS COMPANY? IF YES, WHEN?

DO YOU HAVE ANY RELATIVES WHO WORK FOR THIS COMPANY? IF YES, NAME & RELATIONSHIP

DO YOU SPEAK ANY OTHER LANGUAGE THAN ENGLISH? IF YES, WHAT LANGUAGUE DO YOU SPEAK?

DO YOU HAVE RELIABLE TRANSPORTATION?

DO YOU HAVE ANY CRIMINAL CONVICTIONS OR ANY PENDING CRIMINAL CHARGES, IN ANY STATE? IF YES, EXPLAIN

HAVE YOU EVER BEEN CONVICTED OR PLEAD GUILTY TO FELONY OR MISDEMEANOR? IF YES EXPLAIN

ARE YOU AUTHORIZED TO WORK IN THE UNITED STATES?

YES

JOB HISTORY

ARE YOU CURRENTLY EMPLOYED?

YES

IF YOU ANSWERED YES TO THE PREVIOUS QUESTION, PLEASE COMPLETE THE FOLLOWING:

NAME OF CURRENT EMPLOYER

ADDRESS (INCLUDE CITY AND STATE)

TELEPHONE

YOUR POSITION

IMMEDIATE SUPERVISOR

DATE OF EMPLOYMENT: MONTH/YEAR

REASON FOR SEEKING CHANGE

FULL-TIME OR PART-TIME

FULL-TIME

PART-TIME

CURRENT SALARY

MAY WE CONTACT YOUR CURRENT EMPLOYER?

YES

BRIEFLY DESCRIBE YOUR DUTIES

NOT INCLUDING YOUR PRESENT EMPLOYER, DESCRIBE PREVIOUS POSITIONS BEGINNING WITH THE MOST RECENT:

NAME OF EMPLOYER

ADDRESS (INCLUDE CITY AND STATE)

TELEPHONE

YOUR POSITION

IMMEDIATE SUPERVISOR

DATES OF EMPLOYMENT FROM (MONTH/YEAR) TO (MONTH/YEAR)

FULL-TIME OR PART-TIME

FULL-TIME

PART-TIME

REASON FOR LEAVING

BREIFLY DESCRIBE YOUR DUTIES

REFERENCES

PLEASE PROVIDE THREE (3) PROFESSIONAL REFERENCES who are NOT RELAVTIVES. Include the individual's name, title, company address, phone number, and relationship to you.

I understand and agree that: 1. The information that I provided on this application is true and complete to the best of my knowledge. Any misrepresentation or omission of any fact in my application, resume, or any other materials, or during any interviews, can be justification for refusal of employment or, if employed, termination from this company’s employ. 2. I authorize my present and former employers and those individuals I have listed as business references to furnish information about my employment pertinent to my qualifications for employment, hereby releasing them from any liability for damages arising from furnishing the requested information. 3. I hereby authorize this facility to investigate my employment and personal history, including an inquiry concerning information on my criminal, credit, education, and driving histories, if appropriate. I understand that the facility will consider material contained in my criminal history records solely for the purpose of determining my suitability for the position(s) for which I have applied. 4. In consideration of my employment, I agree to comply with the policies, rules, regulations, and procedures of the company and understand that my employment and compensation can be terminated with or without cause or notice at any time, at the option of either the company or myself.

IN ADDITION TO THIS FORM, PLEASE EMAIL YOUR RESUME AND COVER LETTER TO CAREERS@OUTLAWCONVERSIONS.COM TO BE CONSIDERED FOR EMPLOYMENT.

CAREERS

APPLICATION FOR EMPLOYMENT

Please complete the form below