Careers

Pickersgill Application For Employment

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AN EQUAL OPPORTUNITY EMPLOYER

Equal access to programs, services and employment opportunities is available to all persons without regard to race (includes traits associated with race, including hair texture and protective hairstyles), religion, color, sex (including pregnancy), age, ancestry or national origin, disability, marital status, sexual orientation, gender identity, genetic information, or any other basis protected by federal, state, and/or local law. In accordance with the Americans with Disabilities Act and/or applicable state and local laws, applicants requiring reasonable accommodations for the application and/or interview process should notify the Human Resources Department. Examples of reasonable accommodations include making a change to the application process; providing written materials in an alternate format such as braille, large print, or audio recording; using a sign language interpreter; using specialized equipment; or modifying testing conditions.

Name*

First Last

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Mobile #*

Other Phone #

Email Address*

Position(s) applied for*

Date of application*

MM slash DD slash YYYY

Referral Source*

(e.g., Walk-in, Job Posting, Company's Website, etc.)

If necessary, best time to call you is

Hours

Minutes

AM/PM

Preferred manner of contact

Mobile #

Other Phone #

May we contact you at work?

Yes

N/A

If yes, provide work number

If yes, the best time to call your work is

Hours

Minutes

AM/PM

If you are under 18, and it is required, can you furnish a work permit?*

Yes

N/A

If no, please explain:

Have you submitted an application here before?

Yes

If yes, give submission date(s) and position(s):

Application Submission Date

Position

Select the (+) to list additional applications.

Have you ever been employed here before?*

Yes

If yes, Start Date:

Start Date:

Month

Day

Year

End Date:

Month

Day

Year

Is this application a request for reemployment following an extended military leave of absence from this company?

If yes, additional information may be requested.

Yes

Are you lawfully authorized to work in the United States?*

Yes

Date available for work*

Month

Day

Year

Rate of pay?

What is your desired salary range? Low end of range:

From:

High end of range:

To:

Type of employment desired:

Full-Time

Part-Time

Educational Co-Op

Seasonal

Temporary

Will you relocate if job requires it?

Yes

Will you travel if job requires it?

Yes

If they have been explained to you, are you able to meet the attendance requirements of the position?

Yes

N/A

Will you work overtime if required?*

Yes

If no, please explain:

Are you able to perform the "essential functions" of the job for which you are applying (with or without reasonable accommodation)?*

This question is not designed to elicit information about an applicant's disability. Please do not provide information about the existence of a disability, particular accommodation, or whether accommodation is necessary. These issues may be addressed at a later stage to the extent permitted by law.

Yes

Need more information about the job's "essential functions" to respond

Driver's license number required if driving may be required in the job for which you are applying:

State

Have you ever been bonded?

Yes

Have you entered into an agreement with any former employer or other party (such as a noncompetition agreement) that might, in any way, restrict your ability to work for our company?

Yes

If yes, please explain:

Employment History - Employers

Starting with your most recent employer, provide the following information.

Employer #1*

Phone*

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Starting job title*

Final job title*

Employment Start Date*

MM slash DD slash YYYY

Employment End Date*

MM slash DD slash YYYY

Immediate supervisor's name (for most recent position held)

First Last

Supervisor's Title

May we contact this supervisor for reference?

Yes

Later

Why did you leave?*

Summarize the type of work performed and job responsibilities.*

What did you like most about your position?

What were the things you liked least about the position?

Add another employer?*

Yes

Employment History - Employers Continued

Employer #2

Phone

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Starting job title

Final job title

Employment Start Date

MM slash DD slash YYYY

Employment End Date

MM slash DD slash YYYY

Immediate supervisor's name (for most recent position held)

First Last

Supervisor's Title

May we contact this supervisor for reference?

Yes

Later

Why did you leave?

Summarize the type of work performed and job responsibilities.

What did you like most about your position?

What were the things you liked least about the position?

Add another employer?

Yes

Employment History - Employers Continued

Employer #3

Phone

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Starting job title

Final job title

Employment Start Date

MM slash DD slash YYYY

Employment End Date

MM slash DD slash YYYY

Immediate supervisor's name (for most recent position held)

First Last

Supervisor's Title

May we contact this supervisor for reference?

Yes

Later

Why did you leave?

Summarize the type of work performed and job responsibilities.

What did you like most about your position?

What were the things you liked least about the position?

Add another employer?

Yes

Employment History - Employers Continued

Employer #4

Phone

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Starting job title

Final job title

Employment Start Date

MM slash DD slash YYYY

Employment End Date

MM slash DD slash YYYY

Immediate supervisor's name (for most recent position held)

First Last

Supervisor's Title

May we contact this supervisor for reference?

Yes

Later

Why did you leave?

Summarize the type of work performed and job responsibilities.

What did you like most about your position?

What were the things you liked least about the position?

Employment History Continued

Explain any gaps in your employment, other than those due to personal illness, injury, or disability.

If not addressed on previous page, have you ever been fired or asked to resign from a job?

Yes

If yes, please explain:

Skills and Qualifications

Summarize any special training, skills, languages, licenses, and/or certificates that may assist you in performing the position for which you are applying:

Computer Skills

(Include software titles and level of experience, such as basic, intermediate, or advanced.)

Word Processing

Software Titles

Level of Experience