Employment Application

Thank you for your interest in employment at Horizon Coffee & Water Service.

Fill out and submit the form below. Please try to be as complete as possible.
Employment Application Form
Fields with an (*) asterisk are required.
* Your Full Name:
 * Contact E-mail Address:
* Current Street Address:
 * City:
* State:
 * Zip:
* Contact Phone Number:
 Best time to call:
POSITION
*Position Applying For:
*Full or Part-Time:
*Days Available For Work:
*Hours Available For Work:
*Date You Can Begin:
Wage Requirement - $/Hour:
EDUCATION
*Highest Grade Completed:
*Last School Attended:
Highest Degree Received:
Course of Study:
State any special/technical training you have had:
HEALTH
*Do you have any physical or mental impairments which would interfere with, or prevent you from performing the tasks involved in the job for which you are applying?
If yes, please explain:
EMPLOYMENT HISTORY
List your past/current employers over the past 10 years. If more than 4, list the most recent beginning with your current or most recent employer.
Employer #1 Name:
Your Position
$/Hour
Dates of Work:
Reason For Leaving:
Employer #2 Name:
Your Position
$/Hour
Dates of Work:
Reason For Leaving:
Employer #3 Name:
Your Position
$/Hour
Dates of Work:
Reason For Leaving:
Employer #4 Name:
Your Position
$/Hour
Dates of Work:
Reason For Leaving:
EMPLOYMENT HISTORY (Continued)
*May we contact your previous employers?
*Have you ever been convicted of a crime in the past 10 years, other than a misdemeanor or summary offense which has been annulled?
If no, specify which employer, and the reason why.
If yes, explain.
*Have you ever been bonded?
If yes, name the employer:
*Are you over 18 years of age?
*Are you legally eligible for employment in the U.S.?
REFERENCES
Please, List 3 References. Do not include relatives.
Reference 1.

*Name:
*Address:
*Telephone
Reference 2.

*Name:
*Address:
*Telephone
Reference 3.

*Name:
*Address:
*Telephone
TERMS AND CONDITIONS
Please read the following statements carefully, then check the "I Accept" box and submit the Application.

It is unlawful to discriminate against individuals making an application for employment on the basis of age, race, sex, color, national origin, religious creed, handicap or veteran status.
I hereby certify that the facts set forth in this employment application are true and complete to the best of my knowledge. I understand that falsification of any of the facts contained in this application shall be considered grounds for immediate dismissal. Further, I hereby give the company permission to investigate and verify the information on the application.

Further, I acknowledge that I may be subject to a motor vehicle report, criminal record check, and credit report as part of the pre-employment process, and while I am employed by the company, should I be offered employment.

Finally, any prospective employee may be required to submit to a drug screen test. A positive result to this test will result in the rescinding of an offer of employment, or termination after employment.

I acknowledge that this application does not constitute an offer of work. If I am offered employment by the company, I acknowledge that the company is an at will employer. Accordingly, both the employee and employer are free to terminate the employment relationship without cause or notice. There does not exist any contract or guarantee of employment.
I Accept
*By checking "I Accept" you agree to the Terms and Conditions listed above.
CLICK HERE TO CANCEL YOUR SUBMISSION.