General Employment Application

Name*
First Middle Last
Present Address*
Street Address Address Line 2 City State ZIP Code
How long at current address:*
Social Security No.*
Telephone - Home*
Telephone - Cell*
Email Address
Are you under the age 18?*
- Yes
- No
Can you provide proof of your eligibility to work?*
- Yes
- No
Are you currently authorized to work in the United States?*
Proof of eligibility will be required if hired.
- Yes
- No
Have you ever applied to Nappie's Food Service before?*
- Yes
- No
Employment Desired*
- Full- Time Only
- Part-Time Only
- Temporary/Seasonal
Position:
When are you available to start work?*
MM slash DD slash YYYY
Are you currently employed?*
- Yes
- No
How many hours can you work weekly?*
What is your availability?*
Please include time frames with your availability for the following days. Click the plus button to the right to add multiple time frames.
Sunday Monday Tuesday Wednesday Thursday Friday Saturday
Education*
Please include information for any high school, college, business or trade school, or professional schooling received. Click the plus button to the right to add additional schooling.
Name of School Location Number of Years Completed Major & Degree
Have you ever been convicted of a crime?*
(A Conviction record will not necessarily disqualify you from employment.)
- Yes
- No
How did you hear about the position?*

UNDER PENNSYLVANIA LAW MOST EMPLOYERS MAY NOT REQUIRE OR DEMAND, AS A CONDITION OF EMPLOYMENT, OR PROSPECTIVE EMPLOYMENT OR CONTINUED EMPLOYMENT, THAT AN INDIVIDUAL SUBMIT TO OR TAKE A POLYGRAPH, LIE DETECTOR OR SIMILAR TEST OR EXAMINATION AS A CONDITION OF EMPLOYMENT OR CONTINUED EMPLOYMENT.
Have you ever been in the armed forces?*
- Yes
- No
Are you now a member in the armed forces?*
- Yes
- No
Please list your military experience.
Specialty Date entered Discharge date
Work Experience

Please list your work experience beginning with your most recent job held. If you were self-employed, give firm name.
Name of Current or Last Employer*
Current or Last Employer Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Current or Last Employer Phone Number*
Current or Last Employer - Name of Last Supervisor*
First Last
Current or Last Employer - Last Job Title
Current or Last Employer (Start Date)*
MM slash DD slash YYYY
Current or Last Employer (End Date)*
MM slash DD slash YYYY
Current or Last Employer Pay or Salary (Start)*
Current or Last Employer Pay or Salary (Final)*
Current or Last Employer Reasons for Leaving (Be Specific)*
May we contact your present employer?*
- Yes
- No
Name of Second Past Employer
Second Past Employer Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Second Past Employer Phone Number
Second Past Employer - Name of Last Supervisor
First Last
Second Past Employer - Last Job Title
Second Past Employer (Start Date)
MM slash DD slash YYYY
Second Past Employer (End Date)
MM slash DD slash YYYY
Second Past Employer Pay or Salary (Start)
Second Past Employer Pay or Salary (Final)
Second Past Employer Reasons for Leaving (Be Specific)
Name of Third Past Employer
Third Past Employer Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Third Past Employer Phone Number
Third Past Employer - Name of Last Supervisor
First Last
Third Past Employer - Last Job Title
Third Past Employer (Start Date)
MM slash DD slash YYYY
Third Past Employer (End Date)
MM slash DD slash YYYY
Third Past Employer Pay or Salary (Start)
Third Past Employer Pay or Salary (Final)
Third Past Employer Reasons for Leaving (Be Specific)
Name of Fourth Past Employer
Fourth Past Employer Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Fourth Past Employer Phone Number
Fourth Past Employer - Name of Last Supervisor
First Last
Fourth Past Employer - Last Job Title
Fourth Past Employer (Start Date)
MM slash DD slash YYYY
Fourth Past Employer (End Date)
MM slash DD slash YYYY
Fourth Past Employer Pay or Salary (Start)
Fourth Past Employer Pay or Salary (Final)
Fourth Past Employer Reason for Leaving (Be Specific)
References*
List below THREE persons not related to you, whom you have known at least one year. Click the plus button to the right to add additional references.
Name How do you know them? Phone Number Years Known
AUTHORIZATION
PLEASE READ CAREFULLY. If you are to be hired by the company, you will be required to attest to your identity and employment eligibility and to present documents confirming your identity and employment eligibility. You cannot be hired if you cannot comply with these requirements.
Authorization - Applicant Signature*
I certify that the facts contained in this application and attached resume is applicable are true and complete to the best of my knowledge. I understand that any misrepresentation or material omission made by me on this application/resume will be sufficient cause for cancellation of this application or immediate termination of employment if I am employed, whenever it may be discovered. I understand that any employment is conditioned on a background check. I hereby authorize the potential employer to contact, obtain, and verify the accuracy of information contained in this application and/resume from all previous employers, educational institutions, and references. I authorize my former employers and references to disclose information regarding my former employment, character and general reputation to the potential employer, without giving me prior notice of such disclosure. In addition, I release the potential employer, any former employers and all references listed from any and all claims, demands or liabilities arising out of or related to such investigation or disclosure. I also hereby release from liability the potential employer and its representatives for seeking, gathering, and using such information to make employment decisions. I understand and agree that nothing contained in this application, or conveyed during any interview, is intended to create an employment contract. I further understand and agree that if I am hired, my employment will be “at will” and without fixed term, and may be terminated at any time, with or without prior notice, at the option of either myself or the Company. No promises regarding employment have been made to me, and I understand that no such promise or guarantee is binding upon the Company unless made in writing and so long as there is no violation of applicable federal or state law. If I am offered employment I agree to submit to a medical examination and drug test before starting work. If employed, I also agree to submit to a medical examination or drug test at any time deemed appropriate by Nappie’s Food Service and as permitted by law. I consent to such examinations and tests and I request that the examining doctor disclose to the Company the results of the examination, which results shall remain confidential and segregated from my personnel file. I understand that my employment or continued employment, to the extent permitted by law, is contingent upon satisfactory medical examinations and drug test, and if I am hired a condition of my employment will be that I abide by the Company’s Drug and Alcohol Policy. We are an equal employment opportunity employer. We adhere to a policy of making employment decisions without regard to race, color, religion, gender, sexual orientation, national origin, citizenship, age, height, weight, or disability. We assure you that your opportunity for employment with us depends solely on your qualifications. I understand that filling out this form does not indicate there is a position open and does not obligate the Company to hire. If hired, I agree to abide by all Company work rules, policies and procedures. Nappie’s Food Service retains the right to revise its policies or procedures, in whole or in part, at any time. Please sign below.
ARE YOU ABLE TO PERFORM THE ESSENTIAL FUNCTIONS OF THIS JOB WITH OR WITHOUT SPECIAL ACCOMMODATIONS? Please sign below to indicate "Yes."*
THE POSITION THAT YOU ARE APPLYING FOR (TRUCK DRIVER, WAREHOUSE LABORER) REQUIRES THE PHYSICAL DEMANDS OF LIFTING AND CARRYING UP TO 100 LBS. ON AN OCCASIONAL BASIS AND 50-75 LBS. ON A FREQUENT BASIS. THIS LIFTING AND CARRYING IS REPETITIVE THROUGHOUT THE COURSE OF THE DAY AND IS AN ESSENTIAL COMPONENT OF THESE JOBS.
CDL HOLDERS: HAVE YOU EVER BEEN NON-COMPLAINT WITH ANY DOT MANDATED PRE-EMPLOYMENT DRUG OR ALCOHOL TEST WITHIN THE PAST 2 YEARS?*
- Yes
- No
CDL HOLDERS: HAVE YOU EVER BEEN NON-COMPLAINT WITH ANY DOT MANDATED PRE-EMPLOYMENT DRUG OR ALCOHOL TEST WITHIN THE PAST 2 YEARS? Please sign below.*
Date*
MM slash DD slash YYYY
CAPTCHA

Name of School	Location	Number of Years Completed	Major & Degree

Specialty	Date entered	Discharge date

Name	How do you know them?	Phone Number	Years Known

General Employment Application

Work Experience

AUTHORIZATION