Haversack, LLC APPLICATION FOR EMPLOYMENT

Haversack, LLC is an equal opportunity employer. Haversack, LLC does not discriminate in employment with regard to race, color, religion, national origin, citizenship status, ancestry, age, sex (including sexual harassment), sexual orientation, marital status, physical or mental disability, military status or unfavorable discharge from military service or any other characteristic protected by law.

Incomplete information could disqualify you from further consideration. Please complete all fields.

Personal Information

Name

First

Middle

Last

Phone

Are you eligible to work in the U.S?

Yes

Are you at least 18 years or older? (If no, you may be required to provide authorization to work.)

Yes

Have you ever been terminated from employment or asked to resign by an employer?

Yes

If yes, please provide company names and details

Can you work any shift?

Yes

If no, explain:

Can you work overtime? Including weekends?

Yes

Are you able to perform the essential functions of the job for which you are applying, with or without a reasonable accomodation?

Yes

Employment Desired

Date you can start

Hourly/Salary desired

Position desired

Are you currently employed?

Yes

If so may we contact your present employer?

Referral Source

How did you hear about us?

Have you ever worked for this company before?

Yes

Do you know anyone who works for our company? If yes who?

Education

Highest level of education

Employment History

Include your last seven (7) years of employment history, including periods of unemployment, starting with the most recent and working backwards in time. Incomplete information could disqualify you from further consideration.

From

Employer Name

Telephone

Job Title

Address

Immediate supervisor and title

Summarize the nature of work performed and job responsibilities

From

Employer Name

Telephone

Job Title

Address

Immediate supervisor and title

Summarize the nature of work performed and job responsibilities

From

Employer Name

Telephone

Job Title

Address

Immediate supervisor and title

Summarize the nature of work performed and job responsibilities

Upload Resume

Please read carefully before signing.

I understand that neither the completion of this application nor any other part of my consideration for employment establishes any obligation for Haversack to hire me. If I am hired, I understand that either Haversack, LLC or I can terminate my employment at any time and for any reason, with or without cause and without prior notice. I understand that no representative of Haversack, LLC has the authority to make any assurance to the contrary.

I attest with my electronic signature below that I have given to Haversack, LLC true and complete information on this application. No requested information has been concealed. I authorize Haversack, LLC to contact references provided for employment reference checks. If any information I have provided is untrue, or if I have concealed material information, I understand that this will constitute cause for the denial of employment or immediate dismissal.

THIS APPLICATION IS VALID ONLY FOR 60 DAYS FROM THE DATE SUBMITTED

Your Signature

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