Application For Employment We are an equal opportunity employer and do not discriminate based upon race, color, age, sex, religion, handicap, national origin or veteran status 1Personal Information2Employment History3Education4Apply First NameMiddle NameLast NameAddress Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Telephone #Cell Phone #Email Position Applying ForDate MM slash DD slash YYYY Are you legally authorized to work in the United States? Proof of legal authority to work in the United States will be required upon employment. Yes No Employment Type Full Time Part time Temporary Seasonal Shift 1st Shift 2nd Shift Any Rate of Pay($)Frequency of PayAvailable Start Date MM slash DD slash YYYY Are you atleast 18 years Yes No Referred By: (Please check applicable box and specify if other source) Agency Internet Site, please specify Conhagen Employee School, please specify Newspaper, please specify Other, please specify Referral Details EmploymentEmployerAddressJob TitleEmployed From MM slash DD slash YYYY Employed To MM slash DD slash YYYY Starting PayEnding PayOther CompensationName of SupervisorTitle of SupervisorReason for LeavingMay we contact this employer? Yes No Phone Add EmploymentRemove EmploymentPlease explain periods of non-employment High SchoolName and Location of SchoolNumber of Years CompletedMajor or Type of CourseworkDegree/ CertificateDid you graduate? Yes No Business / TechnicalName and Location of SchoolNumber of Years CompletedDegree/ CertificateDid you graduate? Yes No CollegeName and Location of SchoolNumber of Years CompletedMajor or Type of CourseworkDegree/ CertificateDid you graduate? Yes No Graduate / ProfessionalName and Location of SchoolNumber of Years CompletedMajor or Type of CourseworkDegree/ CertificateDid you graduate? Yes No OtherOther (Seminars, Adult Education, Correspondence Courses) If you are applying for a position where driving is a requirement of the job, please answer the following questions:Do you have a valid driver’s license? Yes no License #Issuing StateExp. Date MM slash DD slash YYYY Within the past three years: How many moving violations have you had?How many traffic accidents have you had?Why are you seeking employment at this time?In what computer software programs are you proficient?What other experiences or skills do you feel may qualify you for this position?Have you previously been employed by any Conhagen company? Yes No If yes, which Company?Position(s) heldUnder what name?From MM slash DD slash YYYY To MM slash DD slash YYYY Reason for LeavingAre you subject to any employment agreement that could impact your ability to work for Conhagen? Yes No Yes, please attach copy of the agreement(s)Max. file size: 485 MB.Please attach resume and/or cover letter if availableMax. file size: 485 MB.AgreementAll persons shall have equal employment opportunities with Alfred Conhagen, Inc “Conhagen” regardless of race, color, creed, religion, national origin, ancestry, sex, marital status, sexual orientation, disability, age and any other legally protected class and within the framework of federal law regarding age discrimination, employment of the handicapped and Vietnam era veterans. Employment shall be based solely on the Company’s need and the individual’s qualifications. I certify that I have completed this application and the statements I have made in this application are true and complete. I authorize investigation of all statements contained in this application which Conhagen may deem relevant to my employment and authorize my previous employers or other persons having information concerning my records or me to report such information to Conhagen. I hereby release Conhagen, my former employer or other persons who may provide information from any liability as a result of providing such information. I understand and agree that if it is subsequently discovered that the information is untrue or that I have failed to disclose a material fact, any offer of employment made to me by Conhagen may be immediately withdrawn or if I am already employed by Conhagen, I may be subject to immediate dismissal at Conhagen’s option. In such event, the withdrawal of any offer of employment made to me or the termination of employment shall be without any obligation or liability to me by Conhagen, other than for wages at the rate agreed upon for work I have actually performed for Conhagen. If I become employed, in consideration of my employment, I understand that I must comply with the rules, regulations, policies and procedures of the company. I am aware of and understand the physical requirements of the job and certify that I can and will perform these requirements in a safe manner, with or without accommodation. In accordance with the Immigration and Control Act of 1986 Conhagen will only hire United States citizens and aliens lawfully authorized to work in the United States. I understand that I will be required to complete the designated employment eligibility verification I-9 Form as a condition of employment. I understand that I may be required to undergo drug testing and/or a background check and that my employment is contingent upon these results. I will be advised if this is required and complete the necessary authorizations. I understand that I am not obligated to disclose sealed or expunged records of conviction or arrest, nor may Conhagen ask me if I have had records sealed or expunged. I understand and agree that if I am employed as a result of this application, my employment will be at at-will, which I understand means that I will not be employed for any definite period of time and that my employment may be terminated at any time. At-will employment may only be modified by written agreement signed by an Officer of the Company.CAPTCHA