Personal Information
Position applying for:
Required
Desired pay:
Required
First name:
Required
Middle name:
Last name:
Required
Street address:
Required
City, state, zip:
Required
Previous street address:
Previous city, state, zip:
Telephone number:
Required
Email:
Required
Are you 18 years of age or older?
Required
Yes No
Driver's license number:
Required
Employment Eligibility
Are you legally eligible for employment in the United States?
Required
Yes No
If not a U.S. citizen, state current Visa or Immigration status:
Are you employed now?
Required
Yes No
May we contact your present employer?
Required
Yes No
Are you dependable?
Required
Yes No
Overtime:
Required
Yes No
Limitations/Restrictions:
Can you perform the essential functions of a job at Winters Performance with or without reasonable accommodations?
Required
Yes No
If "No," explain why:
Have you been convicted of a misdemeanor or felony that remains on your record?
Required
Yes No
If "Yes," for what?
Where?
When?
Are you a military veteran?
Required
Yes No
Branch of service:
Entry date:
Discharge date:
Rank at discharge:
Type of discharge:
History
Education - years completed:
Required
4 5 6 7 8 9 10 11 12
Did you receive a high school diploma?
Required
Yes
University / College (years completed):
Required
0 1 2 3 4
College diploma:
Required
Yes No
High school attended:
Required
City and state:
Required
Year:
Required
College/Other school attended:
Required
Major course of study:
Required
City and state:
Required
Year:
Required
Accredited - diploma/degree
Required
Yes No
Describe any additional training, apprenticeship(s), skills, or activities that may benefit the job applied for:
Required
Previous employer 1:
Required
Employer telephone number:
Required
Employer address:
Required
Job title:
Required
Name and title of supervisor:
Required
May we contact?
Required
Yes No
Dates employed:
Required
Starting hourly rate/salary:
Required
Final hourly rate/salary:
Required
Description of duties:
Required
Reason for leaving:
Required
Previous employer 2:
Employer telephone number:
Employer address:
Previous employer 2:
Employer telephone number:
Employer address:
Job title:
Name and title of supervisor:
May we contact?
Yes No
Employment dates:
Starting hourly rate/salary:
Final hourly rate/salary:
Description of duties:
Reason for leaving:
Previous employer 3:
Employer telephone number:
Employer address:
Job title:
Name and title of supervisor:
May we contact?
Yes No
Employment dates:
Starting hourly rate/salary:
Final hourly rate/salary:
Description of duties:
List special skills or qualifications:
Reference name 1:
Required
Reference company and position:
Required
Reference telephone number:
Required
How do you know the person:
Required
Years known:
Required
Reference name 2:
Required
Reference company and position:
Required
Reference telephone number:
Required
How do you know the person:
Required
Years known:
Required
Reference name 3:
Required
Reference company and position:
Required
Reference telephone number:
Required
How do you know the person:
Required
Years known:
Required
Have you ever applied or worked for Winters Performance?
Required
Yes No
If yes, what were the dates:
Final position:
Reason for leaving:
Do you have any relatives currently employed by Winters Performance:
Required
Yes No
Relative name:
Relationship:
Position:
Have you ever been dismissed or forced to resign from any employment:
Required
Yes No
If yes, which employer and why:
State any additional information you feel may be helpful to us in considering your application;
Referral source:
Required
** None Walk-in applicant Employee referral
If referral from employee, enter employee name:
Applicant's Authorization and Certification
I acknowlege and understand that falsification or misrepresentation of the information requested on this application or with respet to any other information provided in the hiring process will be sufficient cause for the denial or termination of employment, regardless of when such fact may be discovered.
I understand that, if offered a position, the offer may be contingent upon my satisfactorily completing pre-employment screening procedures, which may include a physical, drug testing, skills testing and a background screen.
In submitting this application for employment, I authorize Winters Performance to inquire into my educational background, past employment history, and personal character, and I understand that my current and/or former employers and the references listed above may be contacted to provide information concerning my suitability for employment. I expressly authorize Winters to conduct such inquiries, and release Winters and any responding parties from any and all liability associated with such inquiries.
I understand that in th eevent that I am hired, I will be hired as an at-will employee, and my employment may be terminated at any time, with or without cause, at the option of either the Company or myself. I understand that no representative of the Company except the Owners or President has any authority to enter into any legally binding employment agreement.
By entering my name below, I certify that I have read this employment application, including all information that I have provided on the application, and the entire statement set forth immediately above. I further certify that all of the information that I have provided on this employment application is true and correct.
Type full name:
Required
Date of application:
Required
