Employment Application Applicant InformationName* First Middle Initial Last Address* Street Address City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Home PhoneCell Phone*Email* Date Available*Job Posting IDPosition Applying For:*Position Type:Full TimePart TimeSeasonal / InternshipAvailable to Work:* Days Evenings Weekends Where did you hear about us? Company Website Craigslist Facebook Local Paper Current Employee Referral Outside Referral Other Have you ever worked for this company before?*YesNoAre you legally eligible to work in the U.S.?*YesNo(if offered employment, you will be required to provide documentation to verify eligibility.)EducationSchool #1Name of School*Address* City State / Province / Region Grade Completed*Did you graduate?*YesNoMajor*School #2Name of SchoolAddress City State / Province / Region Grade CompletedDid you graduate?YesNoMajorSchool #3Name of SchoolAddress City State / Province / Region Grade CompletedDid you graduate?YesNoMajorPrevious EmploymentPast Employer #1Company Name:Address City State / Province / Region PhoneSupervisor Name:OK to Contact:YesNoEmployed From: Date Format: MM slash DD slash YYYY Employed To: Date Format: MM slash DD slash YYYY Job Title:Starting Pay Rate:Ending Pay Rate:Reason for Leaving:Past Employer #2Company Name:Address City State / Province / Region PhoneSupervisor Name:OK to Contact:YesNoEmployed From: Date Format: MM slash DD slash YYYY Employed To: Date Format: MM slash DD slash YYYY Job Title:Starting Pay Rate:Ending Pay Rate:Reason for Leaving:Past Employer #3Company Name:Address City State / Province / Region PhoneSupervisor Name:OK to Contact:YesNoEmployed From: Date Format: MM slash DD slash YYYY Employed To: Date Format: MM slash DD slash YYYY Job Title:Starting Pay Rate:Ending Pay Rate:Reason for Leaving:ReferencesReference #1NameAddress(Area Code) PhoneOccupationYears knownReference #2NameAddress(Area Code) PhoneOccupationYears knownReference #3NameAddress(Area Code) PhoneOccupationYears knownMilitary ServiceBranchFromToRank at DischargeType of DischargeIf other than honorable, explainDisclaimer and Signature I certify that my answers are true and complete to the best of my knowledge and authorize All American Co-op to verify their accuracy and to obtain reference information on my work performance. If this application leads to employment, I understand that false or misleading information in my application or interview may result in my release. I understand that any employment offered is at will and that either I or the Employer may terminate my employment at any time with or without notice or cause. I hereby give my consent for All American Co-op through an authorized testing service of its choice, to collect blood, urine or saliva samples from me and to conduct any other necessary medical tests to determine the presence of alcohol or controlled substances in accordance to US Department of Transportation Drug & Alcohol Rules and/or All American Co-op policies. I hereby release All American Co-op from any liability arising out of such test or its results. Further, I give my consent for the release of the test results and other relevant medical information to authorized All American Co-op management for appropriate review. If I am accepted for employment by All American Co-op I hereby consent to be tested in the above manner during my employment when, in the determination of a supervisor trained in whether reasonable suspicion exists, or to require me as a driver to undergo drug and/or alcohol testing under ยง382.307.Signature*Date* Date Format: MM slash DD slash YYYY