Employment Application

Applicant Information:
Name*
First Middle Last
Email*
Phone*
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Date Available*
Social Security Number*
Desired Salary*
Position Applied For*
Are you a citizen of the United States?*
- Yes
- No
Are you authorized to work in the U.S.?*
- Yes
- No
Have you ever worked for this company?*
- Yes
- No
When have you worked for this company?*
Have you ever been convicted of a felony?*
- Yes
- No
Explain.*
Education:
Did you go to High School?*
- Yes
- No
High School*
When did you attend?*
Did you graduate?*
- Yes
- No
High School Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Did you go to college?*
- Yes
- No
College*
When did you attend?*
Did you graduate?*
- Yes
- No
College Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Did you go to a different school?*
- Yes
- No
Explain*
When did you attend?*
Did you graduate?*
- Yes
- No
School/Other Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

HAVE YOU EVER BEEN CONVICTED OF A FELONY OR MISDEMEANOR CRIME?*
- Yes
- No
Convicted of*
Sentence*
Location*
Date*
If you answered yes, list all convictions including military trial, DUI, DWI, drunk, reckless driving, hit and run, or any other conviction. Failure to disclose a conviction is cause for disqualification or dismissal, if employed. Conviction of a crime will not necessarily disqualify you for employment with Power House. Factors such as the nature of the offense, the date, the surrounding circumstances and the relevance to the position applied will be considered.
Are you 21 years of age?*
- Yes
- No
Are you prevented from lawfully becoming employed in this country?*
- Yes
- No
Explain any periods of time in which you did not work in the last five years.*
Are there any hours/days/shifts in which you could not work?*
Based on your review of the job description for the position you are seeking, are you able to perform the essential functions of the job, with or without reasonable accommodation?*
Please state any additional job-related information you feel may be helpful to us in considering your application. (Optional)
Signature*