Application for Employment

   

 

   
Date:              
Last Name:   First Name:   Middle Name:  
Present Address:            
Street:   City:   State:  
Zip Code:  
Permanent Address: (if different from present address)      
Street:   City:   State:  
Zip Code:  
Business Phone:   Home Phone:   SSN:   - -
Employment Desired:          
Position:              
Personal Information:            
Have you ever applied to or worked for Kemco before? Yes   No If yes, when?
Do you have any friends/ relatives working for Kemco? Yes   No      
  If yes, state their name and relationship to you:          
Name:   Relationship:        
Name:   Relationship:        
Why are you applying for work at Kemco?  
     
If hired, would you have reliable transportation to and from work? Yes No      
Are you at least 18 years old? (If you are under 18, hire is subject to verification that you are of minimum legal age.)   Yes No
If hired, can you present evidence of your U.S. citizenship or proof of your legal right to live and work in this country?   Yes No
Are you able to perform the essential functions of this job, either with or without reasonable accommodation?   Yes No
  If no,describe the functions that cannot be performed:
 

 (Note: We comply with the ADA and consider reasonable accommodation measures that may be necessary for eligible applicants/employees to perform essential functions. Hire may be subject to passing a medical examination, and to skill and agility tests.)

Have you ever been convicted of a criminal offense (felony or serious misdemeanor)? (Convictions for marijuana-related offenses that are more than two years old need not be listed.)   Yes   No
 

If yes, 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 nature of the offense, date of the offense,
the surrounding circumstances and the relevance of the offense to the position(s) applied for may, however, be considered.)

Education, Training and Experience:          
High School:            
Name:   City:   Yrs Completed:  
      Graduate?   Yes No Degree/Diploma?  
College:                
Name   City:   Yrs Completed:  
      Graduate   Yes No Degree/Diploma?  
Employment History:            
List below all present and past employment starting with your most recent employer (last five years is sufficient). Account for all periods of unemployment. You must complete this section even if attaching a resume.
Employer 1:            
Name:   Business Type:   Phone Number:  
Supervisor:              
Address:   City:   State:  
Zip Code:  
Dates of Employment: Hourly Pay:                
From:   to Starting:   Ending:          
Please describe your position and duties:                  
           
Reason for leaving:
May we contact this employer for a reference? Yes No            
Employer 2:                  
Name   Business Type:   Phone Number:  
Supervisor                    
Address   City   State  
Zip Code:  
Dates of Employment: Hourly Pay:                
From:   to Starting:   Ending:          
Please describe your position and duties:                  
           
Reason for leaving:
May we contact this employer for a reference? Yes No            
Employer 3:                  
Name   Business Type:   Phone Number:  
Supervisor                    
Address   City   State  
Zip Code:  
Dates of Employment: Hourly Pay:                
From:   to Starting   Ending:            
Please describe your position and duties:                  
           
Reason for leaving:
May we contact this employer for a reference? Yes   No            

Please Read Carefully, Initial Each Paragraph and Sign Below

           
 

I hereby certify that I have not knowingly withheld any information that might adversely affect my chances for employment and that the answers given by me are true and correct to the best of my knowledge. I further certify that I, the undersigned applicant, have personally completed this application. I understand that any omission or misstatement of material fact on this application or on any document used to secure employment shall be grounds for rejection of this application or for immediate discharge if I am employed, regardless of the time elapsed before discovery.

 

I hereby authorize the company to thoroughly investigate my references, work record, education and other matters related to my suitability for employment and, further, authorize the references I have listed to disclose to the company any and all letters, reports and other information related to my work records, without giving me prior notice of such disclosure. In addition, I hereby release KEMCO, my former employers and all other persons, corporations, partnerships and associations from any and all claims, demands or liabilities arising out of or in any way related to such investigation or disclosure.

 

I understand that nothing contained in the application, or conveyed during any interview which may be granted or during my employment, if hired, is intended to create an employment contract between me and the company. In addition, I understand and agree that if I am employed, my employment is for no definite or determinable period and may be terminated at any time, with or without prior notice, at the option of either myself or KEMCO, and that no promises or representations contrary to the foregoing are binding on KEMCO unless made in writing and signed by me and the company’s designated representative.

  Should a search of public records (including records documenting an arrest, indictment, conviction, civil judicial action, tax lien or outstanding judgment) be conducted by internal personnel employed by KEMCO. I am entitled to copies of any such public records obtained by KEMCO unless I initial the  box below. If I am not hired as a result of such information, I am entitled to a copy of any such records even though I have checked the box below.
   I waive receipt of a copy of any public record described in the paragraph above.
Date:   Signature:            
          Please type full name as electronic signature          
 
   
 
         
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3520 College Blvd. Suite 205 Oceanside, CA 92056 Telephone: 1-760-806-6835