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Personal Information

Your Name (First, Middle, Last) *

Have you ever been employed under a different name?

Yes
No

If yes, state the name(s) and dates used:

Name(s)

Dates

Your Address

Street

City

State

Zip

Contact Info

Phone Number *

Email Address *

How did you hear about us? (Please check all that apply)

Website
School
Agency
Job Posting
Other

Please give us more detail if any of the above are checked:

Referred by current/former employee? Please provide name:

Work Preference as a Worker Bee

Please indicate days you are available to work:

Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday

Date available to start

Do you have any commitments to another employer that might affect your start date with us?

Yes
No

If yes, please explain

General Information

Have you previously applied with us?

Yes
No

If yes, give date

Are you legally authorized to work in the United States?

Yes
No

Have you been convicted of - or plead guilty or "no contest" - to any felony or misdemeanor (do not include minor traffic violations) in the past 10 years?

Yes
No

If yes, please provide the name of the crime, date and place of conviction:

Have you ever been discharged or asked to resign by an employer?

Yes
No

If yes, please explain:

Do you have a valid Drivers License?

Yes
No

If yes, DL state:

DL number:

Current/Most Recent Employer

Employer Name

Employer Address

Employer telephone number

Fax number

Position Title(s)

Name of Supervisor

Dates employed:

From

To

Ending Wage (Hourly or Salary)

Brief description of duties:

Still employed?

Yes
No

If Yes, may we contact?

Yes
No

If not, why did you leave? (check one)

Termination
Resignation
Layoff
Mutual Agreement
Other

Reason:

If you have a current resume, please attach

Choose file or drag here

.pdf, .jpg or .doc

temp-for-108711-file2-1_

Second Most Recent Employer

Employer Name

Employer Address

Employer telephone number

Fax number

Position Title(s)

Name of Supervisor

Dates employed:

From

To

Ending Wage (Hourly or Salary)

Brief description of duties:

Still employed?

Yes
No

If Yes, may we contact?

Yes
No

If not, why did you leave? (check one)

Termination
Resignation
Layoff
Mutual Agreement
Other

Reason:

Education

High School

Name of High School

Address

Number of years completed

Degree obtained

College

Name of College

Address

Number of years completed

Degree obtained

Graduate or Professional School

Name or Graduate or Professional School

Address

Number of years completed

Degree obtained

Trade, Night or Online School

Name of Trade, Night or Online School

Address

Number of years completed

Degree obtained

Other

Licenses and Certifications

License/Certification Name

License/Certification Type

State

Date

Actions Against?

License/Certification Name

License/Certification Type

State

Date

Actions Against?

References

Reference #1

Name

Business or Personal?

Business
Personal

Years Known

Contact Information

Reference #2

Name

Business or Personal?

Business
Personal

Years Known

Contact Information

Reference #3

Name

Business or Personal?

Business
Personal

Years Known

Contact Information

Certification

Please read the following statements carefully before sending.

I hereby affirm that the information provided on this application (and accompanying resume, if any) is true and complete to the best of my knowledge. I also acknowledge that any falsified information may disqualify me from further consideration for employment and may be justification for dismissal if discovered at a later date. Any omission from the complete employment record would constitute a falsehood. *

I Agree

I understand that should I become employed by Bee Organized I would be an employee at will. Thus, my employment could be terminated, with or without cause, at any time at the discretion of either the firm or myself. I understand that no management official other than the President has any authority to enter into any agreement contrary to the foregoing or make any oral assurance or promise of continued employment. *

I Agree

Unless specifically noted on this application, I authorize the Company to contact persons, schools, my current employer (if applicable), and previous employers and organizations named in this application (and accompanying resume, if any) to provide any relevant information concerning my employment or other relationship with the organization to the Company. *

I Agree

Thank you for your interest in Bee Organized. We look forward to meeting you!

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