+ General Application

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• Darifill Employment Application

  An Equal Opportunity Employer

  DariFill is an equal opportunity employer. This application will not be used for limiting or excluding any applicant from consideration for employment on a basis prohibited by local, state, or federal law. Applicants requiring reasonable accommodation in the application and/or interview process should notify DariFill.
  
  If you are providing us with a resume that contains information asked for below, you may mark those sections “see resume”. Email resume to hr@darifill.com

• Applicant Information

• First Name*
• Last Name*
• Home Phone*
• Other Phone
• Email*
• Current Address*
  (include city, state, and zip code)
• How did you learn about this position?

• Employment Position

• Position(s) applying for*
• Hours*
  Select one
  • Regular full-time
  • Regular part-time
  • Temporary / Intern / Co-op
• What days and hours are you available to work?*
• Can you work on the weekends if needed?*
  • Yes
  • No
• Can you work evenings if needed?*
  • Yes
  • No
• Can you available to work overtime if needed?*
  • Yes
  • No
• Salary desired

• Personal Information

• Do you have any friends, relatives, or acquaintances working for Darifill?*
  • Yes
  • No
• State name and relationship:
• If hired, would you have transportation to/from work?*
  • Yes
  • No
• Are you over the age of 18? (If under 18, hire is subject to verification of minimum legal age.)*
  • Yes
  • No
• If hired, would you be able to present evidence of your U.S. citizenship or proof of your legal right to work in the United States?*
  • Yes
  • No
• If hired, are you willing to submit to and pass a controlled substance test?*
  • Yes
  • No
• Are you able to perform the essential functions of the job for which you are applying, either with / without reasonable accommodation?*
  • Yes
  • No
• Please describe the functions that cannot be performed:

• (Note: DariFill complies with the ADA and will consider reasonable accommodation measures that may be necessary for eligible applicants/employees to perform essential functions. It is possible that a hire may be tested on skill/agility and may be subject to a medical examination conducted by a medical professional.)

• Education, Training and Experience

• High School

• Name of High School
• High School city, state
• Number of years completed
• Did you graduate?
  • Yes
  • No

• ---

• College/ University

• Name of College/ University
• College/ University city, state
• Number of years completed
• Did you graduate?
  • Yes
  • No
• Degree/ Diploma earned:

• ---

• Vocational School

• Name of Vocational School
• Vocational School city, state
• Number of years completed
• Did you graduate?
  • Yes
  • No
• Degree/ Diploma earned:

• ---

• Military

• Branch
• Rank in Military
• Total years of service
• Skills/ Duties
• Related details

• ---

• Additional Information

• Do you speak, write or understand any foreign languages?
  • Yes
  • No
• If yes, describe which language(s) and how fluent of a speaker you consider yourself to be.
• Do you have any other experience, training, qualifications, or skills which you feel should be brought to our attention, in the case that they make you especially suited for working with us? If yes, please explain

• Employment History

• Are you currently employed?*
  • Yes
  • No
• If you are currently employed, may we contact your current employer?*
  • Yes
  • No

• Below, please describe past and present employment positions, dating back five years. Please account for all periods of unemployment.

• Name of Employer
• Name of Supervisor
• Phone
• Employer Address
• Business Type

• Dates of employment

• From
• To
• Position & Duties
• Reason for leaving

• ---

• Name of Employer
• Name of Supervisor
• Phone
• Employer Address
• Business Type

• Dates of employment

• From
• To
• Position & Duties
• Reason for leaving

• ---

• Name of Employer
• Name of Supervisor
• Phone
• Employer Address
• Business Type

• Dates of employment

• From
• To
• Position & Duties
• Reason for leaving

• References

• List below three persons who have knowledge of your work performance within the last five years. Please include professional references only.

• Reference Name
• Phone Number
• Reference Email
• Address
• Employer
• Occupation
• Number of years acquainted

• ---

• Reference Name
• Phone Number
• Reference Email
• Address
• Employer
• Occupation
• Number of years acquainted

• ---

• Reference Name
• Phone Number
• Reference Email
• Address
• Employer
• Occupation
• Number of years acquainted

• Factuality Agreement

• Please read and initial each paragraph
  I certify that I have not purposely withheld any information that might adversely affect my chances for hiring. I attest to the fact that the answers given by me are true and correct to the best of my knowledge and ability. I understand that any omission (including any misstatement) of material fact on this application or on any document used to secure employment with DariFill can be grounds for rejection of the application or, if I am employed by DariFill, can be terms for my termination from DariFill.

• Initials*

• ---

• I understand that if I am employed, my employment is not definite and can be terminated at any time either with or without prior notice, by either me or DariFill.

• Initials*

• ---

• I understand that if I am employed, my employment is not definite and can be terminated at any time either with or without prior notice, by either me or DariFill.

• Initials*
• Applicant Signature
  I agree to the terms and conditions
• Date
  MM

  DD

  YYYY