IGA Employment Application An Equal Opportunity Employer

Personal Information

First Name*

Middle Name

Last Name*

Phone*

Email*

Alternate Phone

 

 

Street Address*

Apartment

City*

State, Zip*

 

 

 

 

 

 

 

 

 

 

 

 

 

Personal Questions

Question 1*

  Yes   No

Are you willing to work holidays, variable, rotating shifts, nights and weekends?

If no please explain

*

 

Question 2*

  Yes   No

   

Are you under 18 years of age?

If yes, give birth date

*

 

Question 3*

  Yes   No

   

Only United States citizens or aliens who are legally entitled to work in the United States are eligible for employment. Can you, upon employment, submit documentation verifying your identity and your legal right to work in the United States?

 

Question 4*

  Yes   No

   

Have you ever been convicted of or pled guilty, no contest, or received deferred adjudication or probation for any criminal offense, other than for a minor traffic violation?

If yes, give date(s) and details

*

 

Question 5*

  Yes   No

   

Have you ever been discharged or disciplined by an employer for theft, harassment, retaliation, discrimination, disruptive behavior, or using or possessing a weapon on company premises?

If yes, please explain

*

 

Question 6*

  Yes   No

   

Have you ever been discharged or disciplined by an employer for using or possessing illegal drugs and/or illegal substances, or for any other inappropriate conduct?

If yes, please explain

*

 

Question 7*

  Yes   No

   

Do you currently have any relatives working for us?

If yes, who and where?

*

 

Question 8*

  Yes   No

   

Have you ever worked for us before?

If yes, when, where and name of manager:

*

 

Question 9

 

   

Tell us why you would like to work for us.

*

 

Work Amount Desired

 

Full Time   Part Time   Temporary / Seasonal

 

Position

Position Desired

Days and Hours Available for Work

Available to Start

Weekday

Specific Times

Monday

Tuesday

Wednesday

Thursday

Friday

Saturday

Sunday

 

Wage Desired

Wage Desired

Wage Per

 
 

Education: Schools, Colleges & Other Training

(List In Order Of Completion)

High School

 

Name   Years Complete

 Graduated/Completed  Yes   No   Attending

 

College

 

Name   Years Complete

 Graduated/Completed  Yes   No   Attending

 Type of course degree

 

Other 1

 

Name   Years Complete

 Graduated/Completed  Yes   No   Attending

 Type of course degree

 

 

Work History (Include all work history and self-employment, beginning with MOST RECENT or PRESENT EMPLOYER)

Employer 1

 

Employer

Last Position

Supervisor

Street Address

City

State   Zip

Phone

Ending Pay

Employed From To Reason For Leaving   

Duties & Responsibilities

 

May we contact your supervisor as a reference?   Yes     No

 

What did you like most about this position?

 

What did you like least about this position?

 

Employer 2

 

Employer

Last Position

Supervisor

Street Address

City

State   Zip

Phone

Ending Pay

Employed From To Reason For Leaving   

Duties & Responsibilities

 

May we contact your supervisor as a reference?   Yes     No

 

What did you like most about this position?

 

What did you like least about this position?

 

 

Personal or Business References List three additional references (excluding relatives)

Reference 1

 

Name

Company

Position

Street Address

City

State   Zip

Phone

   

I know this person as a
Supervisor    Co-Worker    Friend    Other

 

Reference 2

 

Name

Company

Position

Street Address

City

State   Zip

Phone

   

I know this person as a
Supervisor    Co-Worker    Friend    Other

 

   
 

Policy & Application Agreement

 

The information provided in this application for employment is true, correct and complete. If employed, any misstatement or omission of facts on this application may result in dismissal.
I understand that acceptance of an offer of employment does not create a contractual obligation upon the employer to continue to employ me in the future.

I authorize IGA to contact and/or verify my employment, references or any other background information. Further, I hereby release from all liability or damages those individuals, corporations or organizations who provide such information.
Date:             

Electronic Signature
By checking this box and clicking "Submit employment application to IGA, I electronically sign and submit this application to IGA