Capers Employment - Capers Atl

PERSONAL INFORMATION

Name *

First

Last

Email *

Physical Address

Address Line 1

Address Line 2

City

State

Zip Code

Mailing Address

Address Line 1

Address Line 2

City

State

Zip Code

Home #

Cell #

Work #

Special Questions

The following information is required for a bona fide occupational qualification and other legal reasons.

Height

Weight

Are you 18 years of age or older?

Yes
No

Date of Birth

Place of Birth

Employment Desired

Position

Starting Date

Desired Pay/Salary

Are You Currently Employed

Yes
No

IF YES, MAY WE INQUIRE YOUR PRESENT EMPLOYER?

Yes
No

HAVE YOU EVER APPLIED WITH THIS COMPANY BEFORE?

Yes
No

IF YES, WHEN DID YOU APPLY?

Name of your High School

Did you Graduate from High School?

Yes
No

Graduation Date

Diploma Type

General
Vocational
College Prep

NAME OF COLLEGE

ADDRESS OF COLLEGE

Address Line 1

Address Line 2

City

State

Zip Code

MAJOR/AREA OF STUDY

CREDIT HOURS EARNED

DATE ATTENDED FROM

DATE ATTENDED TO

EMPLOYMENT HISTORY

NAME OF EMPLOYER *

PHONE

JOB TITLE

NAME OF SUPERVISOR

DATES EMPLOYED FROM

DATES EMPLOYED TO

REASON FOR LEAVING

PAY/SALARY

NAME OF EMPLOYER *

PHONE

JOB TITLE

NAME OF SUPERVISOR

DATES EMPLOYED FROM

DATES EMPLOYED TO

REASON FOR LEAVING

PAY/SALARY

EMPLOYMENT RECORD

How many times have you been terminated from a job?

Selected Value: 0

Explain

Would any of your previous employers state that you are ineligible for rehire?

Yes
No

If yes, who?

Explain

How many jobs have you been employed by, where your boss did not like you?

Selected Value: 0

Explain

When was the last time you had disciplinary action taken against you at a job?

Explain

Have you ever been accused, disciplined or terminated from employment, or convicted in the courts for any form of harassment? (Including sexual harassment)

Yes
No

Explain

What illegal drugs, if any, have you used without becoming addicted?

How many people, with whom you have worked, took money?

How many times has a coworker asked you to help take money?

Explain

If not immediately, when do you feel it would be necessary to report such actions to a supervisor?

What would you do if you knew a fellow employee was stealing?

If not immediately, when do you feel it would be necessary to report such actions to a supervisor?

BEFORE AN APPLICANT IS HIRED, WE CONDUCT BACKGROUND CHECKS, WHICH INCLUDE A CRIMINAL RECORDS CHECK. CAPERS ATLANTA NEEDS TO BE SURE THAT NOTHING WILL SHOW UP ON THIS CHECK THAT YOU HAVE NOT ALREADY DISCLOSED.

How many times have you been of probation or parole? Please Explain

Have you committed an act of violence, such as assault, battery, kidnapping, resisting arrest, robbery, etc.?

Yes
No

If so, explain

Have you ever committed an act of theft or fraud, such as larceny, burglary, shoplifting, etc.?

Yes
No

If so, explain

Have you ever committed an act of theft or fraud, such as larceny, burglary, shoplifting, etc.?

Yes
No

If so, explain

Have you been a member of, or participated in, the activities of any “gang” in the past seven years?

Yes
No

If so, explain

Have you ever been convicted of an offense against the law?

Yes
No

If so, explain

Was any conviction pursuant to adjudication in the juvenile court, a youthful offender act, or a first offender act?

Yes
No

If so, explain

If there are any additional charges and / or convictions, please list each offense/charge, date, place, court, and action take below:

Offense

Date / Time

State

County

Disposition

Explain

As you may be aware, this company uses impromptu drug testing methods. What you may, or may not know is that drugs stay in your system for more than 30 days. What illegal drugs are you currently using?

What would you do if you witnessed a fellow employee using drugs while on the job?

AVAILABILITY – Please indicate hours of availability on each given day.

REFERENCES

List two people (non-relatives) you have worked with, that we may contact for a reference.

Reference One Name *

First

Last

Occupation

Phone

Address

Address Line 1

Address Line 2

City

State

Zip Code

Reference Two Name *

First

Last

Occupation

Phone

Address

Address Line 1

Address Line 2

City

State

Zip Code

AUTHORIZATION BACKGROUND INFORMATION RELEASE

Social Security Administration Request: I hereby authorize the Social Security Administration to release Capers Atlanta a DEQY (Detailed Earnings Query) furnishing employer names and addresses for the seven years preceding my dated signature. I hereby authorize the information to be sent to the following:

Capers Atlanta

Substance Abuse Screening: I understand that before any offer of employment is finalized; I may be required to submit to substance abuse testing alcohol, drugs, and controlled substances at a company facility at the company’s expense. In consideration of potential employment with Capers Atlanta, I hereby release Capers Atlanta, its employees and agents from any and all liability which may arise out of or in connection with any substance abuse screening. I understand that such drug screening will consist of the testing of urine sample or other medically recognized test designed to detect traceable amounts of controlled substance in my body. If any detectable amounts are found in my body, a second test, approved by the NIDA, will be performed on the same specimen. If results of the second test are also positive, I will be disqualified from consideration for employment and/or employment from Capers Atlanta. I further understand and agree that if I am employed, I may be required to submit to alcohol/drug testing under and circumstances during my employment.

Background Screening: In consideration of my being considered for employment, I give Capers Atlanta, the right to investigate my background at any time. I authorize and request all persons, companies, and organizations (including credit bureaus, schools, and law enforcement agencies) to furnish any information about me, requested by Capers Atlanta. I release from liability arising from any employment decision which is based, in whole or in part, upon such information.

I certify that the facts contained in this application are true and complete, to the best of my knowledge, and understand that, if employed; falsified statements on the application shall be grounds for dismissal.

Name *

First

Last

Address

Address Line 1

Address Line 2

City

State

Zip Code

Date of Application

We would like for you to submit 2 forms of identification in a jpeg, png or pdf format below

Identification 1

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Identification 2

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Multiple Choice

First Choice
Second Choice
Third Choice