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Application for Employment

Thank you for your interest in joining the Circle S Ranch family! Please complete the form below and someone will be in touch with you soon.

PERSONAL DATA

Full Name

Social Security Number

Phone Number

Email

Street Address

City

State

ZIP Code

What job are you applying for?

Desired schedule

Full-Time Part-Time

Date available to begin work

Communication preference

Email Text Regular Mail

Referred by

Are you legally eligible for employment in the US?

Yes No

Will you now, or in the future, require sponsorship for employment visa status (R-1, H1B visa status)?

Yes No

Do you have reliable transportation to work?

Yes No

If driving may be required in the job for which you are applying, please provide your driver's license information.

State Issued

License Number

Expiration Date

Shifts you are willing to work.

1st Shift 2nd Shift 3rd Shift Any Shift

Wil you work overtime if required?

Yes No

Have you ever been employed here before?

Yes No

If yes, list approximate dates

Reason for leaving?

Are you able to perform the “essential functions” of the job for which you are applying (with or without reasonable accommodations)?

Yes No I need more information about the job’s “essential functions“ to respond.

This question is not designed to elicit information about an applicant’s disability. Please do not provide information about the existence of a disability, particular accommodation, or whether accommodation is necessary. These issues may be addressed at a later stage to the extent permitted by law.

Have you ever been suspended, dismissed, fired, or discharged from a position of employment?

Yes No

Have you ever been asked to resign from a position of employment?

Yes No

Have you ever been convicted of, pleaded guilty or no contest to any violation of the law, other than a minor traffic ticket? A “yes” answer does not automatically disqualify you for employment, since the nature of the offense, date and job for which you are applying will also be considered.

Yes No

If Yes for any of the above, please provide details

EDUCATION

#1 School or Special Training (include City & State)

Years Completed

Did you graduate?

Yes No

Major & Degree / Certification Earned

#2 School or Special Training (include City & State)

Years Completed

Did you graduate?

Yes No

Major & Degree / Certification Earned

#3 School or Special Training (include City & State)

Years Completed

Did you graduate?

Yes No

Major & Degree / Certification Earned

COMPUTER SKILLS

(IF APPLYING FOR AN ADMINISTRATIVE POSITION)

Word

Beginner Intermediate Advanced

Excel

Beginner Intermediate Advanced

Outlook

Beginner Intermediate Advanced

Publisher

Beginner Intermediate Advanced

PowerPoint

Beginner Intermediate Advanced

List any other computer skills

REFERENCES

List at least 3 work-related persons, such as former employers, pastors, supervisors, and instructors, who have first-hand knowledge of your professional preparation, experience, competence, and maturity. No relatives.

Reference #1

Name

Title

Phone

Email

Years Known

Relationship

Reference #2

Name

Title

Phone

Email

Years Known

Relationship

Reference #3

Name

Title

Phone

Email

Years Known

Relationship

EMERENCY CONTACTS

Emergency Contact Name #1

Relationship

Phone

Emergency Contact Name #2

Relationship

Phone

EMPLOYMENT HISTORY

BEGINNING WITH MOST RECENT

Employer #1

Company Name

Date From

Date To

Work Performed

Position/Title

Ending Pay $

Pay Frequency

Weekly Biweekly Monthly

Company City

Company State

Company Phone Number

Reason for leaving

Name & Title of supervisor

May we contact?

Yes No

Employer #2

Company Name

Date From

Date To

Work Performed

Position/Title

Ending Pay $

Pay Frequency

Weekly Biweekly Monthly

Company City

Company State

Company Phone Number

Reason for leaving

Name & Title of supervisor

May we contact?

Yes No

Employer #3

Company Name

Date From

Date To

Work Performed

Position/Title

Ending Pay $

Pay Frequency

Weekly Biweekly Monthly

Company City

Company State

Company Phone Number

Reason for leaving

Name & Title of supervisor

May we contact?

Yes No

Explain any gaps in employment, other than those due to personal illness, injury or disability

I certify that all the information submitted by me on this application for employment are true and complete. I understand that if any false or misleading statements, misrepresentations, or omissions on my application are discovered, my application will be rejected. It shall be considered sufficient cause for dismissal if found at a later date, and disqualify me for future employment. You are hereby authorized to make any investigation on my personal history including a background check.

In connection with my application for employment (including contract or volunteer services) with Circle S Ranch and Circle S Shavings (“Company”), I understand investigative consumer reports may also be obtained by Company and its Agency. These reports may include information gathered from personal interviews, as applicable, with former employers, past or current associates of mine, etc., to gather information regarding my work, character, general reputation, mode of living and personal characteristics, and professional or educational qualifications may be obtained. You may request more information about the nature and scope of an investigative consumer report, if any, by contacting the Company. I understand that I have rights under the Fair Credit Reporting Act, and I acknowledge receipt of the Summary of Rights by signing this form.

I understand that employment at this organization is “at will,” and includes no guarantee, contract, or promise of employment for any specified length of time.

I agree to conform to the company’s rules and regulations, and I understand that these rules and/or the Employee Handbook do not form a contract of employment, either expressed or implied, and I agree that my employment and compensation can be terminated, with or without cause and with or without notice at any time, at either my or Circle S Ranch’s option. I also understand that the terms and conditions of my employment may be changed, with or without cause or without notice, at any time by Circle S Ranch.

I authorize the use of any information in this application and any attached supplements to verify my statements, and I authorize the past employers, doctors, all references, and any other persons to answer all questions asked concerning my ability, character, reputation, and previous employment record. I release all such persons from any liability or damages on account of having furnished such information.

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