First Name
*
Middle Initial
A
B
C
D
E
F
G
H
I
J
K
L
M
N
O
P
Q
R
S
T
U
V
W
X
Y
Z
Last Name
*
Email
*
Today's Date
MM
DD
YYYY
Address
*
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Phone
*
(###)
###
####
Are you a US Citizen or legally authorized to be employed in the United States
*
Yes
No, please explain
How did you hear about openings at Newtrax?
*
Through Agency
Print Advertisement
Referred by employee
Open House/Job Fair
Walk-in
On a bus
On our building
Other, see below
Other places you heard about openings
Equal Opportunity Employer- We are an Equal Opportunity employer and we do not and will not discriminate on the basis of Race, Religion, National Origin, Sex, Age, Disability, Marital Status, status as a Disabled Veteran, or any other characteristic protected by law. Information provided on this application will not be used for any discriminatory purpose.
*
Check that you acknowledge statement
I have read the above statement
Last or Present Employment
Type of businesss
Address of Employer
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Name of Supervisor
First Name
Last Name
Phone of Supervisor/Business
(###)
###
####
Reason for leaving
Dates worked
Title, Type, or Classification of Position
Brief description of duties
Next to Last Employment
Type of business
Address of Employer
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Name of Supervisor
First Name
Last Name
Phone of Supervisor/Business
(###)
###
####
Reason for leaving
Dates Worked
Title, Type, or Classification of Position
Brief description of duties
Institution Type
*
High School
Technical/Trade
College
Other
Address
Educational History Institution Address 1
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Graduated
Graduated Educational History 1
Yes
No
Institution Type
High School
Technical/Trade
College
Other
Address
Educational History Institution Address 2
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Graduated
Graduated Educational History 2
Yes
No
Institution Type
High School
Technical/Trade
College
Other
Address
Educational History Institution Address 3
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Graduated
Graduated Educational History 3
Yes
No
Computer Skill
Office/ Clerical Skills
Other
Apprenticeship
Reference 1
*
First Name
Last Name
Phone
*
Reference 1
(###)
###
####
Reference 2
First Name
Last Name
Phone
Reference 2
(###)
###
####
Reference 3
First Name
Last Name
Phone
Reference 3
(###)
###
####
May we contact your present employer?
*
Yes
No
Are you 23 years of age or older
*
Yes
No
Date Available
*
MM
DD
YYYY
I hereby certify that the answers and other information on this application are true and correct and that I understand any misrepresentation or omission of facts on my part will be justification for separation from the company's service, if employed. I understand that my employment may be contingent upon receipt of an Alien Registration number, verification of right to work, and any other pertinent information bearing upon my employment, and that my continued employment depends upon the will of the Company or myself.
I Certify
Name
First Name
Last Name
Date
MM
DD
YYYY
Gender
Male
Female
Neither
Position
Race/Ethnic Category
Please indicate ONE Race/Ethnic group you most strongly identify yourself as. The groups are defined by the Equal Employment Opportunity Commission as:
Hispanic or Lattino- a person of Cuban, Mexican, Puerto Rican, South or Central American, or other Spanish culture or origin regardless of race.
Caucasian/White (not Hispanic or Latino) All persons having origins in any of the original peoiples of Europe, North Africa or the Middle East
Black or African American (not Hispanic or Latino) All persons having origins in any of the black racial groups of Africa
Native Hawaiian or other Pacific Islander (not Hispanic or Latino) All persons having origins in any of the peoples of Hawaii, Guam, Samoa, or other Pacific Islands
Asian (not Hispanic or Latino) All persons 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.
American Indian or Alaskan Native (not Hispanic or Latino) All persons having origins in any of the original peoples of North and South America (including Central America), and who maintain tribal affiliation or community attachment
Two or more races (not Hispanic or Latino) All persons who identify with more than one of the above 5 races
Other (not Hispanic or Latino)
Veterans Status
Disabled Veteran
Recently Separated Veteran
Armed Forces Service Medal Veteran
Other Veteran