Varflex Corporation Application Form Applicant InformationFirst Name*First Name Middle Initial*Middle Initial Last Name*Last Name Address* Address Line 1 Address Line 2 City State Zip Code Phone*PhoneE-mail Address*E-mail Address Position/AvailabilityPosition Applying For*Position Applying For Full-Time or Part-Time Work?*Full-Time or Part-Time Work Full-Time Part-Time Either Shift AvailabilityShift Availability Days Afternoons Midnights Any Work Schedule*What days/times are you available to work? WeekendsCan you work weekends? Yes No OvertimeCan you work overtime? Yes No When Can You Start?*When Can You Start? Personal InformationHave 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.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 InformationHigh School*High School: High School City* City High School State* State High School Years Completed*Number of Years CompletedYears1234High School Graduation*Did you graduate?YesNoDegree/diploma earned:*Degree/diploma earned: College/UniveristyCollege/University #1: College/Univeristy City City College/University State State College/University Years CompletedNumber of Years CompletedYears1234College/University GraduationDid you graduate?YesNoCollege/University DiplomaDegree/diploma earned: College/University #2College/University #2: College/University #2 City City College/University #2 State State College/University #2 Years CompletedNumber of Years CompletedYears1234College/University #2 GraduationDid you graduate?YesNoCollege/University #2 DegreeDegree earned: Vocational School Vocational School City City Vocational School State State Vocational School Years CompletedNumber of Years CompletedYears1234Vocational School GraduationDid you graduate?YesNoVocational School CertificationCertification 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?YesNoIf you are currently employed, may we contact your current employer?*If you are currently employed, may we contact your current employer?YesNoBelow, 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 Employer #1 End DateEnd Date 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?YesNo 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 Employer #2 End DateEnd Date Employer #2 Job TitleJob Title Employer #2 DutiesDutiesEmployer #2 ReasonReason for Leaving Employer #2 ContactMay we contact this employer for references?YesNoEmployer #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 Employer #3 End DateEnd Date Employer #3 Job TitleJob Title Employer #3 DutiesDutiesEmployer #3 ReasonReason for Leaving Employer #3 ContactMay we contact this employer for references?YesNoMilitary ServiceMilitary 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.CAPTCHAEmailThis field is for validation purposes and should be left unchanged.
