Employment Application

Thank you for your interest in a career with Shady Lane.

Personal Information

Name *

First

Last

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Phone *

Email *

Are you 18 years of age or older? *

How did you learn of Shady Lane, Inc.? If recommended by an employee of Shady Lane, Inc. please give name; also indicate previous employment with us or date(s) or prior application, if applicable. *

Have you ever been convicted of any crime other than a minor traffic violation, or are your currently facing any criminal charges? *

A criminal record does not constitute an automatic bar to employment and will be considered only as it relates to the job in question, in accordance with applicable law. If yes is answered to the question, explain: *

If hired, can you give written evidence of your right to work in the USA as required by applicable law *

Employment Desired

Position applied for: *

Availability: *

Full-time
Part-time
Temporary

Shift availability: *

Day
PM
Nights
Any Shift

Any objection to weekend work? *

Any objection to overtime? *

Wage expectation: *

Educational Background

Highest Level of Education *

Name the last school attended: *

If college/vocational, programs(s) studied: *

References

Please give three persons not related to you whom you have known at least one year.

Name *

First

Last

Phone *

Email *

Address

Address Line 1

Address Line 2

City

State

Zip Code

Years known: *

Name *

First

Last

Phone *

Email *

Address

Address Line 1

Address Line 2

City

State

Zip Code

Years known: *

Name *

First

Last

Phone *

Email *

Address

Address Line 1

Address Line 2

City

State

Zip Code

Years known: *

Give the name(s) of anyone you know who is employed by Shady Lane, Inc.:

Former Employment

List below your work experience, starting with your present or last place of employment:

Employer *

Phone *

Position *

Start date *

End date *

End wage

Supervisor *

Reason for leaving *

Employer

Phone

Position

Start date

End date

End wage

Supervisor

Reason for leaving

Employer

Phone

Position

Start date

End date

End wage

Supervisor

Reason for leaving

Have you ever been disciplined or fired? *

If yes, explain:

May we contact you present employer at this time? *

List any additional information, qualification, accomplishment's, special skills, etc. that you feel may be helpful to us in considering your application: *

Agreement & Understanding

I understand that: *

Any employment by Shady Lane Inc. will be on an "at will" basis. "At will" means that Shady Lane, Inc. may terminate my employment at any time, for any reason, with or without notice. I understand that, if I am hired, I may similarly terminate my employment at any time, for any reason, with or without notice.
This statement services as my declaration that the above information is complete and true to the best of my knowledge. I understand that discovery of any material misrepresentation or elaborate omission of a fact in my application may be justification for refusal of, or if employed immediate termination of my employment.
I authorize Shady Lane, Inc. to contact any/or all of my references and prior employers for full information. It is my understanding that Shady Lane, Inc. may make a thorough investigation of my entire work and personal history and may verify all data given in my application for employment, related papers, or oral interviews. I authorize such investigations and the giving and receiving of any information requested by Shady Lane, Inc. and I release from liability any person giving or receiving any such information. I understand that falsification of data investigation may prevent my being hired, or if hired, may subject me to immediate termination of employment. I understand that Shady Lane, Inc. performs arrest and conviction checks.
I agree that Shady Lane, Inc. at any time without liability may terminate my employment for wages or salary except such as may have been earned at the date of such termination. If requested by management at any time, I agree to submit to search of my person or of any locker that may be assigned to me, and I hereby waive all claims for damages on account of such examination. I understand that I may be required to take a physical examination, at Shady Lane, Inc.'s request by a physician of Shady Lane, Inc.'s choice at any time to determine if I am physically fit for the job I am to perform, and I authorize the examining physician, hospital or clinic to disclose to Shady Lane, Inc. or an authorized agent of Shady Lane, Inc., any information which may be necessary to determine my ability to perform the duties of the job.
Although management makes every effort to accommodate individual preferences, business needs may at time make the following conditions mandatory: overtime, shift work, a rotating work schedule, or fill-in work. Also, it is understood that unless otherwise informed, weekend work is a job requirement.

By typing your name, you certify that all information contained in this Application for Employment is true and accurate to the best of your knowledge and belief; and have read, understood, and agree to be legally bound to all of the terms in the Applicant Statement and Agreement. *

Employment Reference Check

The person identified below is being considered for employment and has signed the authorization for this inquiry. We would appreciate a statement of your experiences with this person when your company employed him/her.

Applicant's Name *

Applicant's Social Security Number *

I authorize Shady Lane, Inc. to contact any/or all of my references and prior employers for full information. It is my understanding that Shady Lane, Inc. may make a thorough investigation of my entire work and personal history and may verify all data given in my application for employment, related papers, or oral interviews. I authorize such investigations and the giving and receiving of any information requested by Shady Lane, Inc. and I release from liability any person giving or receiving any such information. I understand that falsification of data investigation may prevent my being hired, or if hired, may subject me to immediate termination of employment. I understand that Shady Lane, Inc. performs arrest and conviction checks.

By typing your name, you authorize Shady Lane to contact any/or all refernces and prior employers for full information. *