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EMPLOYMENT APPLICATION

We consider applicants for all positions without regard to race, color, religion, sex, national origin, age, disability or any other legally protected status.

 

Personal Information

First Name

Last Name

Address

City

State

Zip Code

Phone Number

Email

Are you under the age of 18?
 Yes No
If hired, on what date will you be available to work?

Do you know anyone or have any relatives employed by Straub's?
 Yes No
If yes...
Name

Relationship

Which Location?

Education Information

High School

Name

Location

Years Completed
 9 10 11 12
Did you Graduate?
 Yes No
Degree/Course of Study

College

Name

Location

Years Completed
 1 2 3 4 5+
Did you Graduate?
 Yes No
Degree/Course of Study

Other

Name

Location

Did you Graduate?
 Yes No
Degree/Course of Study

Job Information

What Prompted Your Application?

Position(s) Applying for:

Position

Expected Pay Rate

Position

Expected Pay Rate

Do you want...
 Full-Time Part-Time

Specify days & hours you are available to work:

Mon
Tue
Wed

Thu
Fri
Sat

Sun

Work History

List Present/Most Recent Employer First

Company Name

Supervisor

Address

City

State

Zip Code

Phone

Dates Employed

From
      
To

Rate of Pay

Start
      
End

State Job Title & Describe Your Work
Reason For Leaving

Employer #2

Company Name

Supervisor

Address

City

State

Zip Code

Phone

Dates Employed

From
      
To

Rate of Pay

Start
      
End

State Job Title & Describe Your Work
Reason For Leaving

Employer #3

Company Name

Supervisor

Address

City

State

Zip Code

Phone

Dates Employed

From
      
To

Rate of Pay

Start
      
End

State Job Title & Describe Your Work
Reason For Leaving

Legal History

Have you ever been convicted of, or pleaded guilty to, a felony?
 Yes No
If yes, decribe in full. Convictions will not necessarily disqualify an applicant from employment.

Other Comments

Occasionally the form of an application blank makes it difficult for individuals to adequately summarize their complete background.

With that in mind please list any other special skills or qualifications that you would like us to consider.

Important: Read Carefully

I authorize present and former employers, and individuals I have listed as personal references, to furnish information about my employment record, including a statement of the reason for the termination of my employment, work performance, abilities, and other qualities pertinent to my qualifications for employment, hereby releasing them from any and all liability for damages arising from furnishing the requested information.

I certify that the information contained in this application is correct to the best of my knowledge. If employed, I understand that the falsification of this information may result in my dismissal. I authorize the investigation of all statements contained in this application for employment as necessary in arriving at an employment decision. I understand that my employment may be terminated, with or without notice, by the Company for any reason, including lack of work, unsatisfactory performance, improper behavior or any other reason which, in the sole judgment of the Company, constitutes a basis for termination of employment.

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