Customer Service: 1-800-659-2211 or 413-423-3300
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APPLICATION FOR EMPLOYMENT
To Applicant: We deeply appreciate your interest in our organization and assure you that we are sincerely interested in your qualifications. A clear understanding of your background and work history will aid us in placing you in the position that best meets your qualifications so we ask that you fill out the ENTIRE application completely. Our company is committed to a policy of non-discrimination and equal opportunity for all employees and qualified applications without regard to race, color, religious creed, national origin, ancestry, sex, age, handicap, veteran's status or sexual orientation. ONLY NON SMOKERS CONSIDERED FOR EMPLOYMENT AT THIS TIME.
PERSONAL
Date
Date Picker
Last Name*
First Name*
Middle Name
Social Security No.
Present Address
Street
City
State
Zip
Telephone*
Are you a U.S citizen ?*
If not, do you have legal authorization to work in this country ?
Are you 18 or older?*
Do you have relatives working for this company?*
Do you smoke?*
Do you have any physical condition which may limit your ability to perform the job applied for ?
NOTE (This question is voluntary and any answers will be kept confidential.)
Whom should we notify in case of emergency?
Name
Telephone No.
Have you ever been convicted of a felony?*
If yes, give dates and details of conviction ("An applicant for employment with a sealed record on file with the commissioner of probation may answer 'no record' with respect to any injury herein relative to prior arrests, criminal court appearances or convictions. In addition, any applicant for employment may answer 'no record' with respect to any inquiry relative to prior arrests, court appearances and adjudications in all cases of delinquency or as a child in need of services which did not result in a complaint transferred to the superior court for criminal prosecution.")
EMPLOYMENT DESIRED
Position(s) applied for*
Rate of pay desired $
Date available
Date Picker
Are you presently employed ?
If so, may we inquire of your current employer?
Referral source: Advertisement (Please name the publication)
Referral
Walk in
Other
Were you previously employed by us ?
If yes, when
Briefly describe the type of work for which you are best qualified. Note any details about your qualifications which should be considered. Include special skills, machines operated. licenses, professional affiliations, activities, honors and awards, publications, patents, etc... Please exclude information regarding organizations, the name of character of which, indicates the race, age, sex, color or national origin of its members.
EMPLOYMENT/EDUCATION HISTORY
EDUCATION AND/OR MILITARY TRAINING
High School
Name and Address
Course of Study
Last Year Completed
Did you Graduate ?
List Diploma or Degree
College
Name and Address
Course of Study
Last Year Completed
Did you Graduate ?
List Diploma or Degree
Others Specify
Name and Address
Course of Study
Last Year Completed
Did you Graduate ?
List Diploma or Degree
RECORD OF EMPLOYMENT
Please list below all present and past employment, beginning with your most recent. You may include any verified work history performed on a volunteer basis.
Employer Details 1
Name and Address
From (Mo)
From (Yr)
To (Mo)
To (Yr)
Starting Salary($)
Last Salary($)
Reason for leaving
Name of supervisor
Last position held
Telephone
Describe the work you did
Employer Details 2
Name and Address
From (Mo)
From (Yr)
To (Mo)
To (Yr)
Starting Salary($)
Last Salary($)
Reason for leaving
Name of supervisor
Last position held
Telephone
Describe the work you did
Employer Details 3
Name and Address
From (Mo)
From (Yr)
To (Mo)
To (Yr)
Starting Salary($)
Last Salary($)
Reason for leaving
Name of supervisor
Last position held
Telephone
Describe the work you did
Employer Details 4
Name and Address
From (Mo)
From (Yr)
To (Mo)
To (Yr)
Starting Salary($)
Last Salary($)
Reason for leaving
Name of supervisor
Last position held
Telephone
Describe the work you did
If there is a particular employer(s) you do not wish us to contact, please indicate which one(s).
PERSONAL REFERENCES
Name and Occupation
Address
Telephone No.
Years Acquainted
Name and Occupation
Address
Telephone No.
Years Acquainted
Name and Occupation
Address
Telephone No.
Years Acquainted
Note: It is unlawful in Massachusetts to require or administer a lie detector test as a condition of employment. An employer who violates this law shall be subject to criminal penalties and civil liability.
PLEASE READ AND SIGN BELOW
I authorize investigation of all statements contained in this application. The facts set forth in my application for employment are true and complete. I understand that if employed, any false statement or omission of facts called for on this application are cause for dismissal. I further understand that this application is not and is not intended to be a contract of employment, that my (possible) employment is for no definite period and may, regardless of the date of payment of my wages and salary, be terminated at any time without any previous notice.
Signature of Applicant
Date
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