Application for Employment

• Referred by:
• Date Available for Work:
• Have you ever been employed by Birkey's before?

  Yes No
  
• If yes, when and what location:

Personal Details

• First Name:
• Middle Initial:
• Last Name:
• Address:
• City:
• State:
• Zip:
• Cell Phone:
• Email Address:
• Are you legally entitled to work in the United States?

  Yes No
  
• Have your driving privileges ever been revoked or suspended?

  Yes No
  
• If yes, list here when and why:
• Do you currently hold a Commercial Driving License (CDL)?

  Yes No
  

Education

• High School (Name and Address)
• Did you graduate?

  Yes No
  
• If no, last grade completed:
• G.E.D. Obtained?

  Yes
• Grade Point Average:
• College (Name and Address):
• Did you graduate?

  Yes No
  
• If no, number of hours completed:
• Grade Point Average:
• Degree:
• Major:
• Minor:
• If attending, date of graduation:
• Other Education:
• Awards, Honors, Leadership Roles:

Military

• List service in U.S. Military
• From:
• To:
• Rank at Discharge:
• Military experience that maybe applicable to working here:

General Employment Information

• List here all of the equipment with which you have experience and training (Examples: cash register, small tools, forklift, word processor, calculator, computers, etc.):
• Are you willing to relocate:

  Yes No
  
• If yes, state location preferred:
• Salary Expected:
• Number of hours you are available per week:
• Type of Employment sought:

  No Preference
  regular full time
  regular part time
  temporary
  seasonal
  as needed
  
• In the following space, please describe briefly why you are applying for this position:
• In the following space, please describe your strengths and talents and how our company will benefit from your work here:

Which of the following are you available:

• Days:

  Yes No
  
• Nights:

  Yes No
  
• Weekends:

  Yes No
  
• Holidays:

  Yes No
  
• Shift Work:

  Yes No
  

Indicate hours you are available to work on the following days (or write Anytime, if you have no restrictions:

• Monday:
• Tuesday
• Wednesday
• Thursday
• Friday
• Saturday
• Sunday
• Are you able and willing to perform the essential functions of the job for you are applying, including travel, if necessary?

  Yes No
  Don't Know
  
• If no, indicate reason:

  Need different hours
  Need different days
  Need more training
  Change in duties
  
• Other, (explain accommodation needed):
• Are you currently under a non-compete agreement that will prevent you from working for any business in our industry?

  Yes No
  
• If yes, please explain and list the date the agreement expires:

Experience: list below all present and past employment, beginning with your most recent employer:

Employer #1

• Employer:
• Address:
• Starting Salary:
• Last Salary:
• Kind of Business:
• Job Title:
• Date Employed from:
• Date Employed to:
• Supervisor:
• Reason for Leaving:

  Quit
  Discharge
  Retired
  Laid Off
  
• Why?
• For Job Reference Call (Name):
• For Job Reference Call (Phone):
• Can Birkey's contact this employer?

  Yes No
  
• If not, why?
Add Another Employer

Employer #2

• Employer:
• Address:
• Starting Salary:
• Last Salary:
• Kind of Business:
• Job Title:
• Date Employed from:
• Date Employed to:
• Supervisor:
• Reason for Leaving:

  Quit
  Discharge
  Retired
  Laid Off
  
• Why?
• For Job Reference Call (Name):
• For Job Reference Call (Phone):
• Can Birkey's contact this employer?

  Yes No
  
• If not, why?
Add Another Employer

Employer #3

• Employer:
• Address:
• Starting Salary:
• Last Salary:
• Kind of Business:
• Job Title:
• Date Employed from:
• Date Employed to:
• Supervisor:
• Reason for Leaving:

  Quit
  Discharge
  Retired
  Laid Off
  
• Why?
• For Job Reference Call (Name):
• For Job Reference Call (Phone):
• Can Birkey's contact this employer?

  Yes No
  
• If not, why?

Resume and Cover Letter

• Upload Resume

  *
• Upload Cover Letter

Conditions of Employment

• By checking this box and submitting this electronic application, I affirm that I have read and I agree to the conditions of the application above, and that all information I have provided in this application is correct and complete to the best of my knowledge.

  Yes, I agree to the above conditions of Employment
  

• Submit