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Applicant Information

First Name*

First Name

Middle Initial*

Middle Initial

Last Name*

Last Name

Address*

Address Line 1 Address Line 2 City State Zip Code

Phone*

Phone

E-mail Address*

E-mail Address

Position/Availability

Position Applying For*

Position Applying For

Full-Time or Part-Time Work?*

Full-Time or Part-Time Work?

Select All
Full-Time
Part-Time

Shift Availability*

Shift Availability

Select All
Days
Afternoons
Midnights

Work Schedule*

What days/times are you available to work?

Weekends*

Can you work weekends?

Overtime*

Can you work overtime?

When Can You Start?*

When Can You Start?

Personal Information

Have you ever worked for Varflex Corporation before?*

Have you ever worked for Varflex Corporation before?

Yes
No

If so, when?*

If so, when?

Have you ever applied to work for Varflex Corporation before?*

Have you ever applied to work for Varflex Corporation before?

Yes
No

If so, when?*

If so, when?

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
Not Applicable

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

If yes, please describe the crime - state 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 Information

High School*

High School:

High School City*

City

High School State*

State

High School Years Completed*

Number of Years Completed

High School Graduation*

Did you graduate?

Degree/diploma earned:*

Degree/diploma earned:

College/Univeristy

College/University #1:

College/Univeristy City

City

College/University State

State

College/University Years Completed

Number of Years Completed

College/University Graduation

Did you graduate?

College/University Diploma

Degree/diploma earned:

College/University #2

College/University #2:

College/University #2 City

City

College/University #2 State

State

College/University #2 Years Completed

Number of Years Completed

College/University #2 Graduation

Did you graduate?

College/University #2 Degree

Degree earned:

Vocational School

Vocational School City

City

Vocational School State

State

Vocational School Years Completed

Number of Years Completed

Vocational School Graduation

Did you graduate?

Vocational School Certification

Certification earned:

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?

If you are currently employed, may we contact your current employer?*

If you are currently employed, may we contact your current employer?

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 Number

Employer #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

Employer #1 End Date

End Date

Employer #1 Job Title*

Job Title

Employer #1 Duties*

Duties

Employer #1 Reason*

Reason for Leaving

Employer #1 Contact*

May we contact this employer for references?

Employer #2

Employer

Employer #2 Phone

Telephone Number

Employer #2 Supervisor

Supervisor

Employer #2 Business Type

Business Type

Employer #2 Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Employer #2 Start Date

Start Date

Employer #2 End Date

End Date

Employer #2 Job Title

Job Title

Employer #2 Duties

Duties

Employer #2 Reason

Reason for Leaving

Employer #2 Contact

May we contact this employer for references?

Employer #3

Employer

Employer #3 Phone

Telephone Number

Employer #3 Supervisor

Supervisor

Employer #3 Business Type

Business Type

Employer #3 Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Employer #3 Start Date

Start Date

Employer #3 End Date

End Date

Employer #3 Job Title

Job Title

Employer #3 Duties

Duties

Employer #3 Reason

Reason for Leaving

Employer #3 Contact

May we contact this employer for references?

Military Service

Military Service Branch

Branch

Rank at Discharge

Military Service Years

Total Years of Service

Military Service Skills and Duties

Skills and Duties

Military Service Other Details

Other Details

References

Reference #1 First Name*

First Name

Reference #2 Last Name*

Last Name

Reference #1 Phone Number*

Phone Number

Reference #1 Occupation*

Occupation

Reference #1 Relationship*

Relationship to Applicant:

Reference #1 Years Acquainted*

Number of Years Acquainted

Reference #2 First Name

First Name

Reference #2 Last Name

Last Name

Reference #2 Phone Number

Phone Number

Reference #2 Occupation

Occupation

Reference #2 Relationship

Relationship to Applicant:

Reference #2 Years Acquainted

Number of Years Acquainted

Reference #3 First Name

First Name

Reference #3 Last Name

Last Name

Reference #3 Phone Number

Phone Number

Reference #3 Occupation

Occupation

Reference #3 Relationship

Relationship to Applicant:

Reference #3 Years Acquainted

Number of Years Acquainted

EEO-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 Title

Job 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.

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*

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Please attach a resume if you have one available. Please make sure the file is a PDF, DOC, or DOCX file. Thank you.

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Varflex Corporation Application Form

Applicant Information

Position/Availability

Personal Information

Education Information

Special Skills and Qualifications

List job-related licenses, skills, training, honors, awards, and special accomplishments.

Employment History

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.

Military Service

References

EEO-1Voluntary Self Identification Form

Acknowledgements

Please Read and Initial Each Paragraph, then Sign Below

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.