Employment Village of Pepin

Contact Information

Name*

First Middle Last

Email*

Address*

Street Address Address Line 2 City State ZIP Code

Phone Number*

General Employment Information

Position Applied For*

Desired Pay*

Have you ever applied for employment with us?*

Yes
No

Are you able to work full time?*

(Do not include religious holidays)

Yes
No

Are you able to work over time if asked?*

Yes
No

Are You eligible for work in the U.S.?*

Yes
No

Are You 18 years Of Age Or Older?*

Yes
No

Do you posses a valid drivers license?*

Yes
No

When will you be able to start?*

Employer History - Most Recent

Begin With Your Most Recent Employment (1) And Continue With Past Employment

Employer

Address

Street Address City State ZIP Code

Employed From

(mm/yyyy)

Employed To

(mm/yyyy)

Starting Salary

Ending Salary

Your Title(s)

Your Duties

Reason for Leaving

Name & Title of Supervisor

Phone Number

Type of Business

May We Contact Employer?

Yes
No

Employer History - Past Employment 1 of 2

Employer

Address

Street Address City State ZIP Code

Employed From

(mm/yyyy)

Employed To

(mm/yyyy)

Starting Salary

Ending Salary

Your Title(s)

Your Duties

Reason for Leaving

Name & Title of Supervisor

Phone Number

Type of Business

May We Contact Employer?

Yes
No

Employer History - Past Employment 2 of 2

Employer

Address

Street Address City State ZIP Code

Employed From

(mm/yyyy)

Employed To

(mm/yyyy)

Starting Salary

Ending Salary

Your Title(s)

Your Duties

Reason for Leaving

Name & Title of Supervisor

Phone Number

Type of Business

May We Contact Employer?

Yes
No

Explain Any Period Between Jobs

EDUCATION

Education History - List High School and any post High School education. Click the + button on the far right to add additional high schools, colleges, universities, technical colleges, or trade schools

Click the + button on the far right to add additional high schools, colleges, universities, technical colleges, or trade schools

Full Name of School	Major Subject	Highest Grade Or Year Completed	Degree Earned

Additional information about your education history:

Military or Other Special Training/Skills

Military Training or Experience, Other Skills

Tell us about yourself

PERSONAL OR BUSINESS REFERENCES

Add 2 References*

Click the + button on the right to add additional references

Name	Occupation Business Phone Number	Telephone Number	Title/Relationship

Resume

If you have an electronic version (Word, PDF, etc.) of your resume, you may attach it here.

Accepted file types: doc, docx, pdf, jpg, gif, png, Max. file size: 64 MB.

NOTIFICATION AND AGREEMENT

Applicant Statement

I CERTIFY THAT ALL ANSWERS GIVEN BY ME ARE TRUE, ACCURATE AND COMPLETE, I UNDERSTAND THAT THE FALSIFICATION, MISREPRESENTATION OR OMISSION OF FACT ON THIS APPLICATION (OR ANY OTHER ACCOMPANYING OR REQUIRED DOCUMENTS) WILL BE CAUSE FOR DENIAL OF EMPLOYMENT OR IMMEDIATE TERMINATION OF EMPLOYMENT, REGARDLESS OF WHEN OR H0W DISCOVERED.

Questions regarding this statement should be directed to any employment interviewer before signing. The application will be given every consideration, but its receipt does not imply that the applicant will be employed.

It is the policy of the company to afford equal opportunity to all employees and applicants for employment without regard to age, race, religion, color, sex, national origin, marital status, expunged juvenile records, or pregnancy, and to afford equal opportunities to disabled veterans, veterans of the Vietnam era, and individuals with a disability, any and other characteristic protected by Federal, State or Local law.

I authorize the investigation of all statements and information contained in this application. I release from all liability anyone supplying such information and I also release the employer from all liability that might result from making an investigation.

If hired, I agree to abide by all of the company rules and regulation, and understand that, if employed, my employment may be terminated with or without cause, and with or without notice, at any time, at the option of either the company or me, I further understand that no representation, whether oral or written by any representative or agent of the Company, at any time, can constitute a contract of employment. I understand that the Company and all Plan Administrators shall have the maximum discretion permitted by law to administer, interpret, modify, discontinue, enhance or otherwise change all policies, procedures, benefits or other terms or conditions of employment. No representative or agent of the company, has the authority to enter into any agreement for employment for any specified period of time or to make any change in any policy, procedure, benefit or other term or condition of employment other than in a document signed by the President or Executive Vice President, or to make any agreement contrary to the foregoing.

I acknowledge that I have read and understand the above statements and hereby grant permission to confirm the information supplied on this application by me

Signature (Type your initials)

DO NOT SUBMIT UNTIL YOU HAVE READ THE ABOVE APPLICANT STATEMENT

Today's Date

Employment

Employment Opportunities

Employment Application

Contact Information

General Employment Information

Employer History - Most Recent

Employer History - Past Employment 1 of 2

Employer History - Past Employment 2 of 2

EDUCATION

Military or Other Special Training/Skills

PERSONAL OR BUSINESS REFERENCES

NOTIFICATION AND AGREEMENT