Mr. LongArm On-line Job Application Form

APPLICATION FOR EMPLOYMENT

Mr. LongArm, Inc. • P.O. Box 377, Greenwood, MO 64034 • (816) 537-6777

WE PERFORM BACKGROUND CHECKS AND DRUG SCREENS

THIS APPLICATION IS NOT AN EMPLOYMENT CONTRACT, but merely is intended to evaluate suitability for employment. It is the policy of the company to provide equal employment to all qualified persons without discrimination on the basis of sex, race, color, religion, age, marital status, national origin, citizenship, disability, veteran status, or any other status protected under state and federal law. It is also the policy of the company to have the option of conducting pre-employment screening before a job offer is made. If a job offer is made, employment may be contingent upon the successful completion of a medical examination, which may include providing body substance samples. You may request any reasonable accommodation to participate in the application process.

You can submit this form, when completed, by clicking SUBMIT at the bottom of the page. Or, for your convenience, you can click SAVE AND RESUME at the bottom of the page to complete later if needed.

This application will remain active for 180 days.

Position Applied for: *

Date of Application: *

How did you learn about us? *

If other

Name *

First

Middle

Last

Address *

Address Line 1

City

State

Zip Code

Email *

Phone *

Last 4 Digits of your Social Security Number *

If you are under 18 years of age, can you provide required proof of your eligibility to work? *

Have you ever filed an application with us before? *

If yes, provide date:

Have you ever been employed by us before? *

If yes, provide date:

Are you currently employed? *

If yes, employer:

May we contact your present employer? *

Are you prevented from lawfully becoming employed in this country because of Visa or Immigration Status? *

Proof of citizenship or immigration status will be required upon employment.

On what date would you be available to work? *

Are you available to work: *

Are you currently on "layoff" status and subject to recall? *

Can you travel if a job requires it? *

Highest Education Completed *

Name of School *

Address *

Address Line 1

City

State

Zip Code

Describe any specialized training, apprenticeship, skills and extra-curricular activities. *

If not applicable type N/A.

Describe any job-related training received in the United States military. *

If not applicable type N/A.

Employment Experience

Start with your present or last job. Include any job-related military service assignments and volunteer activities. You may exclude organizations that indicate race, color, religion, gender, national origin, disabilities, or other protected status. Explain any gaps in employment in the Comments Section below.

Employer *

Employer Address *

Address Line 1

City

State

Zip Code

Phone *

Job Title *

Reason for Leaving *

Dates Employed *

From/To:

Hourly Rate/Salary *

Starting/Final:

Work Performed *

Supervisor *

First

Last

May We Call? *

Employer *

Employer Address *

Address Line 1

City

State

Zip Code

Phone *

Job Title *

Reason for Leaving *

Dates Employed *

From/To:

Hourly Rate/Salary *

Starting/Final:

Work Performed *

Supervisor *

First

Last

May We Call? *

Employer

Employer Address

Address Line 1

City

State

Zip Code

Phone

Job Title

Reason for Leaving

Dates Employed

From/To:

Hourly Rate/Salary

Starting/Final:

Work Performed

Supervisor

First

Last

May We Call?

State any additional information you feel may be helpful to us in considering your application. *

If not applicable type N/A.

List professional, trade, business, or civic activities and offices held. You may exclude memberships that would reveal gender, race, religion, national origin, age, ancestry, disability, or other protected status: *

If not applicable type N/A.

Additional Information – Other Qualifications. Summarize special job-related skills and qualifications acquired from employment or other experience. *

If not applicable type N/A.

List any specific machinery and other specialized skills here: *

If not applicable type N/A.

References

List name and telephone number of three business/work references who are NOT related to you and are NOT previous Supervisors. If not applicable, list three (3) school or personal references who are not related to you.

Name *

First

Last

Address *

Address Line 1

City

State

Zip Code

Phone *

Email *

Name *

First

Last

Address *

Address Line 1

City

State

Zip Code

Phone *

Email *

Name

First

Last

Address

Address Line 1

City

State

Zip Code

Phone

Must read and sign Applicant’s Statement Below

WE ARE AN AT-WILL, EQUAL OPPORTUNITY EMPLOYER

Applicant's Statement

I understand that any information provided by me that is found to be false, incomplete or misrepresented in any respect, will be sufficient cause to cancel further consideration of this application, or immediately discharge me from the employer's service whenever it is discovered.

I expressly authorize, without reservation, the employer, its representatives, employees or agents to contact and obtain information (such as: dates, employment, salary, job titles, etc.) from all references (personal and professional), employers, public agencies, licensing authorities and educational institutions and to otherwise verify the accuracy of all information provided by me in this application, resume, or job interview. I hereby waive any and all rights and claims I may have regarding the employer, its agents, employees or representatives, for seeking, gathering and using such information in the employment process and all other persons, corporations or organizations for furnishing such information about me.

I understand that the employer does not unlawfully discriminate in employment and no question on this application is used for the purpose of limiting or excusing any applicant from consideration for employment on a basis prohibited by applicable local, state, or federal law. This application for employment shall be considered active for a period of time not to exceed 180 days. Any applicant wishing to be considered for employment beyond this time period should inquire as to whether or not applications are being accepted at that time.

I HEREBY UNDERSTAND AND ACKNOWLEDGE THAT, IF HIRED, MY EMPLOYMENT RELATIONSHIP WITH THIS ORGANIZATION WOULD BE OF AN “AT WILL” NATURE, WHICH MEANS THAT THE EMPLOYEE MAY RESIGN AT ANY TIME AND THE EMPLOYER MAY DISCHARGE EMPLOYEE AT ANY TIME AND FOR ANY OR NO REASON. IT IS FURTHER UNDERSTOOD THAT THIS “AT WILL” EMPLOYMENT RELATIONSHIP MAY NOT BE CHANGED BY ANY WRITTEN DOCUMENT OR BY CONDUCT UNLESS SUCH CHANGE IS SPECIFICALLY ACKNOWLEDGED IN WRITING BY AND SIGNED BY MR. LONGARM, INC. PRESIDENT.

In the event of employment, I understand that false or misleading information given in my application or interview(s) may result in discharge. I understand, also, that I am required to abide by all rules and regulations of the employer. I also understand that if I am hired, I will be required to provide proof of identity and legal authority to work in the United States and that federal immigration laws require me to complete an I-9 Form in this regard.

DO NOT SIGN UNTIL YOU HAVE READ THE ABOVE APPLICANT STATEMENT

I certify that I have read, fully understand and accept all terms of the foregoing Applicant Statement:

Signature *

Date *

Name *

First

Last

Save and Resume Later

APPLICATION FOR EMPLOYMENT

Mr. LongArm, Inc. • P.O. Box 377, Greenwood, MO 64034 • (816) 537-6777

WE PERFORM BACKGROUND CHECKS AND DRUG SCREENS

This application will remain active for 180 days.

Employment Experience

References

Must read and sign Applicant’s Statement Below

*WE ARE AN AT-WILL, EQUAL OPPORTUNITY EMPLOYER*

Applicant's Statement

DO NOT SIGN UNTIL YOU HAVE READ THE ABOVE APPLICANT STATEMENT

WE ARE AN AT-WILL, EQUAL OPPORTUNITY EMPLOYER