First Name
Last Name
Middle Name
Phone Number
Email
Present Address
City
State
Zip Code
Mailing Address (If different from above)
City
State
Zip Code
What Position Are You Applying For?
What Days and Hours are You Available?
Do You Have a Valid Driver’s License?
Are You Applying for:
Full-time
Part-time
Seasonal (summer, holidays)
If Seasonal:
Start Date
End Date
If NO, Do You Have a Permit to Work in the US?
Are You Available to Work on Weekends?
Would You Be Available to Work Overtime If Necessary?
Would You Be Able to Work Overnight Shift?
If Hired, What Date Can You Start Work?
How Did You Hear About Our Company and This Job Opening?
Have You Ever Applied to or Worked for Moving with Grace?
If Yes:
Start Date
End Date
If Hired, Would You Have a Reliable Means of Transportation To and From Work?
Are You At Least 18 Years Old? (If Under 18, Hire is Subject to Verification That You Are of Minimum Legal Age)
Are You Able to Perform the Essential Functions of the Job for Which You Are Applying, Either With or Without Reasonable Accommodation?
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.)
We may refuse to hire relatives of present employees if doing so could result in actual or potential problems in supervision, security, safety, or morale, or if doing so could create conflicts of interests.
List below three persons not related to you who have knowledge of your work performance within the last three years.
First Name
Last Name
Phone Number
Email
Occupation
Number of Years Aquainted
First Name
Last Name
Phone Number
Email
Occupation
Number of Years Aquainted
First Name
Last Name
Phone Number
Email
Occupation
Number of Years Aquainted
High School
No. of Years Completed
Degree or Diploma
College/University
No. of Years Completed
Degree or Diploma
Vocational/Business
No. of Years Completed
Degree or Diploma
Health Care Training
No. of Years Completed
Degree or Diploma
Do You Have Any Other Experience, Training, Qualifications, or Skills That You Feel Make You Especially Suited for Work at Moving with Grace?
If So, Please Explain:
List below all present and past employment starting with your most recent employer (last three years is sufficient). You MUST complete this section if you have not summited a resume.
Title
Company Name
City, State
Start Date
End Date
Type of Business
Supervisor's Full Name
Phone Number
May We Contact for Reference?
Reason for Leaving
Title
Company Name
City, State
Start Date
End Date
Type of Business
Supervisor's Full Name
Phone Number
May We Contact for Reference?
Reason for Leaving
Title
Company Name
City, State
Start Date
End Date
Type of Business
Supervisor's Full Name
Phone Number
May We Contact for Reference?
Reason for Leaving
I further certify that l, 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.
Initials
I hereby authorize MOVING WITH GRACE to thoroughly investigate my references, work record, education and other matters related to my suitability for employment (excluding criminal background information) unless otherwise specified above. I 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 the Company, 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.
Initials
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 the Company, and that no promises or representations contrary to the foregoing are binding on the company unless made in writing and signed by me and the Company's designated representative.
Initials
In compliance with federal law, all persons hired will be required to verify identity and eligibility to work in the United States and to complete the required employment eligibility verification document form upon hire.
Initials
The Company will consider qualified applicants, including those with criminal histories, in a manner consistent with state and local "Fair Chance" laws.
Full Name
Date
Submit