Varflex Corporation Application Form Applicant InformationFirst Name*First Name Middle InitialMiddle Initial Last Name*Last Name Address* Street Address Address Line 2 City State StateAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code Phone*PhoneE-mail Address*E-mail Address Position/AvailabilityPosition Applying For*Position Applying For: Full-Time or Part-Time?*Full-Time or Part-Time? Full-Time Part-Time Any Shift Availability*Shift Availability Days Afternoons Midnights Any What days are you available to work?What days are you available to work? Select All Monday Tuesday Wednesday Thursday Friday Weekends*Can you work weekends? Yes No Overtime*Can you work overtime? Yes No When Can You Start?*When Can You Start? (Example 01/01/2000) MM slash DD slash YYYY Personal InformationHave you ever worked for Varflex Corporation before?*Have you ever worked for Varflex Corporation before? Yes No Date Range*If so when did you start? (Example 01/01/2000) MM slash DD slash YYYY Date*When did it end? (Example 01/01/2000) MM slash DD slash YYYY Have you ever applied to work for Varflex Corporation before?*Have you ever applied to work for Varflex Corporation before? Yes No Date*If so, when? (Example 01/01/2000) MM slash DD slash YYYY Do you have any friends, relatives, or acquaintances working for Varflex Corporation?*Do you have any friends, relatives, or acquaintances working for Varflex Corporation? Yes No If so, who?*If so, who? Driver's License*Do you have a driver's license? Yes No If you do not have a driver's license, do you have reliable transportation?*If you do not have a driver's license, do you have reliable transportation? Yes No If hired, are you willing to submit to and pass a drug test?*If hired, are you willing to submit to and pass a drug test? Yes No Are you able to perform the essential functions of the job for which you are applying, either with/without reasonable acommodation?*Are you able to perform the essential functions of the job for which you are applying, either with/without reasonable acommodation? Yes No If not, describe the functions that cannot be performed:*If not, describe the functions that cannot be performed: Note: Varflex Corporation complies with the ADA and consider reasonable accommodation measures that may be necessary for eligible applicants/employees to perform essential functions. It is possible that a hire may be tested on skill/agility and may be subject to a medical examination conducted by a medical professional.Have you ever been convicted of a criminal offense (felony or misdemeanor)?*Have you ever been convicted of a criminal offense (felony or misdemeanor)? Yes No Please state the nature of the crime(s), when and where convicted, and disposition of the case.*Please state the nature of the crime(s), when and where convicted, and disposition of the case. Note: No applicant will be denied employment solely on the grounds of conviction of a criminal offense. The date of the offense, the nature of the offense, including any significant details that affect the description of the event, and the surrounding circumstances and the relevance of the offense to the position(s) applied for may, however, be considered.Education InformationHigh School*High School: High School City* City High School State* State High School Years Completed*Number of Years CompletedYears1234High School GraduationDid you graduate? Yes No Degree/diploma earned:*Degree/diploma earned: Did you attend college/university?*Did you attend college/university? Yes No Did you attend a vocational school?*Did you attend a vocational school? Yes No College/UniversityCollege/UniveristyCollege/University #1: College/University City City State Country AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaRéunionSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands College/University Years CompletedNumber of Years CompletedYears1234College/University GraduationDid you graduate? Yes No College/University DiplomaDegree/diploma earned: Did you attend a second college/university?Did you attend a second college/university? Yes No College/University #2College/University #2: College/University #2 City City State Country AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaRéunionSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands College/University #2 Years CompletedNumber of Years CompletedYears1234College/University #2 GraduationDid you graduate? Yes No College/University #2 DegreeDegree earned: Vocational SchoolVocational SchoolVocational School Vocational School City City State Country AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaRéunionSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Vocational School Years CompletedNumber of Years CompletedYears1234Vocational School GraduationDid you graduate? Yes No Vocational School CertificationCertification earned: Any additional vocational school experience and certifications can be listed in the Special Skills and Qualifications field. Special Skills and Qualifications List job-related licenses, skills, training, honors, awards, and special accomplishments.Special Skills and Qualifications*Employment History Are you currently employed?*Are you currently employed? Yes No If you are currently employed, may we contact your current employer?If you are currently employed, may we contact your current employer? Yes No Below, please describe past and present employment positions, dating back five years. Please account for all periods of unemployment. Even if you have attached a resume, this section must be completed.Employer #1*Employer Employer #1 Phone*Telephone NumberEmployer #1 Supervisor*Supervisor Employer #1 Business Type*Business Type Employer #1 Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Employer #1 Start Date*Start Date (Example 01/01/2000) MM slash DD slash YYYY Employer #1 End Date*End Date (Example 01/01/2000) MM slash DD slash YYYY Employer #1 Job Title*Job Title Employer #1 Duties*DutiesEmployer #1 Reason*Reason for Leaving Employer #1 Contact*May we contact this employer for references? Yes No Additional Employers*How many additional employers have you had in the past 5 years (not counting the one you listed above)? 0 1 2 3 or more Employer #2Employer Employer #2 PhoneTelephone NumberEmployer #2 SupervisorSupervisor Employer #2 Business TypeBusiness Type Employer #2 Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Employer #2 Start DateStart Date (Example 01/01/2000) MM slash DD slash YYYY Employer #2 End DateEnd Date (Example 01/01/2000) MM slash DD slash YYYY Employer #2 Job TitleJob Title Employer #2 DutiesDutiesEmployer #2 ReasonReason for Leaving Employer #2 ContactMay we contact this employer for references? Yes No Employer #3Employer Employer #3 PhoneTelephone NumberEmployer #3 SupervisorSupervisor Employer #3 Business TypeBusiness Type Employer #3 Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Employer #3 Start DateStart Date (Example 01/01/2000) MM slash DD slash YYYY Employer #3 End DateEnd Date (Example 01/01/2000) MM slash DD slash YYYY Employer #3 Job TitleJob Title Employer #3 DutiesDutiesEmployer #3 ReasonReason for Leaving Employer #3 ContactMay we contact this employer for references? Yes No Any additional employment history can be submitted in a resumé. There is an upload button at the end of this form that will allow you to attach your resumé to send to us. Thank you.Military ServiceHave you served in the armed forces?* Yes No Military Service BranchBranch Rank at DischargeRank at Discharge Military Service YearsTotal Years of ServiceMilitary Service Skills and DutiesSkills and DutiesMilitary Service Other DetailsOther DetailsReferencesReference #1 First Name*First Name Reference #2 Last Name*Last Name Reference #1 Phone Number*Phone NumberReference #1 Occupation*Occupation Reference #1 Relationship*Relationship to Applicant: Reference #1 Years Acquainted*Number of Years AcquaintedReference #2 First NameFirst Name Reference #2 Last NameLast Name Reference #2 Phone NumberPhone NumberReference #2 OccupationOccupation Reference #2 RelationshipRelationship to Applicant: Reference #2 Years AcquaintedNumber of Years AcquaintedReference #3 First NameFirst Name Reference #3 Last NameLast Name Reference #3 Phone NumberPhone NumberReference #3 OccupationOccupation Reference #3 RelationshipRelationship to Applicant: Reference #3 Years AcquaintedNumber of Years AcquaintedEEO-1Voluntary Self Identification Form The Equal Employment Opportunity Commission (EEOC) requires all private employers with 100 or more employees as well as federal contractors and first-tier subcontractors with 50 or more employees AND contracts of at least $50,000 complete an EEO-1 report each year. Covered employers must invite employees to self-identify gender and race for this report. Completion of this form is voluntary and will not affect your opportunity for employment, or the terms or conditions of your employment. This form will be used for EEO-1 reporting purposes only and will be kept separate from all other personnel records only accessed by the Human Resources department. Please complete this form for submission to the HR department. If you choose not to self-identify your race/ethnicity at this time, the federal government requires Varflex Corporation to determine this information by visual survey and/or other available information. EEO-1 First Name*First Name EEO-1 Last Name*Last Name EEO-1 Job TitleJob Title EEO-1 Date*Date EEO-1 Gender*Gender Male Female EEO-1 Race/Ethnicity*Please choose one of the descriptions below corresponding to the ethnic group with which you identify.Hispanic or Latino: A person of Cuban, Mexican, Puerto Rican, South or Central American, or other Spanish culture or origin regardless of race.White (Not Hispanic or Latino): A person having origins in any of the original peoples of Europe, the Middle East or North Africa.Black or African American (Not Hispanic or Latino): A person having origins in any of the black racial groups of Africa.Native Hawaiian or Pacific Islander (Not Hispanic or Latino): A person having origins in any of the peoples of Hawaii, Guam, Samoa or other Pacific Islands.Asian (Not Hispanic or Latino): A person having origins in any of the original peoples of the Far East, Southeast Asia or the Indian Subcontinent, including, for example, Cambodia, China, India, Japan, Korea, Malaysia, Pakistan, the Philippine Islands, Thailand and Vietnam.Native American or Alaska Native (Not Hispanic or Latino): A person having origins in any of the original peoples of North and South America (including Central America) and who maintains tribal affiliation or community attachment.Two or more races (Not Hispanic or Latino): All persons who identify with more than one of the above five races.I do not wish to disclose.Acknowledgements Please Read and Initial Each Paragraph, then Sign Below I certify that I have not purposely withheld any information that might adversely affect my chances for hiring. I attest to the fact that the answers given by me are true & correct to the best of my knowledge and ability. I understand that any omission (including any misstatement) of material fact on this application or on any document used to secure can be grounds for rejection of application or, if I am employed by this company, terms for my immediate expulsion from the company.Acknowledgement #1 Initials*Initials I understand that if I am employed, my employment is not definite and can be terminated at any time either with or without prior notice, and by either me or the company.Acknowledgement #2 Initials*Initials I permit the company to examine my references, record of employment, education record, and any other information I have provided. I authorize the references I have listed to disclose any information related to my work record and my professional experiences with them, without giving me prior notice of such disclosure. In addition, I release the company, my former employers & all other persons, corporations, partnerships & associations from any & all claims, demands or liabilities arising out of or in any way related to such examination or revelation.Acknowledgement #3 Initials*Initials Acknowledgement Full Name*Name Date* Upload Your ResumePlease attach a resume if you have one available. Please make sure the file is a PDF, DOC, or DOCX file. Thank you.Accepted file types: pdf, doc, docx, Max. file size: 14 MB.CAPTCHAPhoneThis field is for validation purposes and should be left unchanged.
