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Employment
Employment at Bear Country USA
Step
1
of
5
20%
PERSONAL DATA:
Name
First
Last
Address
Street Address
Address Line 2
City
State / Province / Region
ZIP / Postal Code
Phone
Messaging Phone
Email
Are you at least 18 years old?
Yes
No
Do you get the I-9 verification?
Yes
No
Are you a citizen of the U.S.?
Yes
No
If “no”, Permanent Residency or work Permit Number
Have you ever been convicted of a crime? (Exclude misdemeanor traffic violations)
(Conviction of a crime does not automatically bar you from employment, but will only be considered in relation to specific job requirements).
Yes
No
If "Yes", date:
Offense:
Is any additional information relative to change of name, use of assumed name, maiden name or nickname necessary to conduct a check of your work record?
Yes
No
List of names by which you are known:
POSITION/JOB INFORMATION:
Position(s) Desired:
Position(s) Desired:
Full Time
Part Time
On Call
Temporary
Date Available
Month
Day
Year
Expected Rate of Pay:
Are you willing to work weekends:
Yes
No
How did you hear about this position?
School
Agency
Walk-In
Newspaper
Bulletin Board
Referral
Other
If referral, who?
Name(s) and relationship(s) of individual(s) you know were previously or are currently in our employ (If none, write “None”):
Have you ever been previously employed by Bear Country U.S.A.?
Yes
No
If so, dates:
Position:
If so, why did you leave:
EDUCATION/SKILLS DATA:
If you are licensed, registered or certified in a profession or trade please indicate:
NAME AND ADDRESS OF LAST ELEMENTARY SCHOOL
INDICATE LAST GRADE COMPLETED
1
2
3
4
5
6
7
8
GRADUATE?
Yes
No
NAME AND ADDRESS OF LAST HIGH SCHOOL
INDICATE LAST GRADE COMPLETED
9
10
11
12
GRADUATE?
Yes
No
COLLEGE OR UNIVERSITY AND ADDRESS
MAJOR SUBJECTS
DATES IN ATTENDANCE
DEGREE OR NUMBER OF CREDITS EARNED
DATE OF LEAVING OR GRADUATION
COLLEGE OR UNIVERSITY AND ADDRESS
MAJOR SUBJECTS
DATES IN ATTENDANCE
DEGREE OR NUMBER OF CREDITS EARNED
DATE OF LEAVING OR GRADUATION
EMPLOYMENT HISTORY: (INCLUDE ANY RELEVANT VOLUNTEER EXPERIENCE)
FIRST PREVIOUS EMPLOYER:
ADDRESS:
PHONE:
TOTAL TIME EMPLOYED:
DUTIES:
REASON FOR LEAVING:
START DATE:
END DATE:
START SALARY:
END SALARY:
JOB TITLE:
SUPERVISOR:
SHIFT TYPE:
FULL TIME
PART TIME
TEMPORARY
ON CALL
IF PART TIME, HOW MANY HOURS A WEEK?
MAY WE CONTACT?
Yes
No
SECOND PREVIOUS EMPLOYER:
ADDRESS:
PHONE:
TOTAL TIME EMPLOYED:
DUTIES:
REASON FOR LEAVING:
START DATE:
END DATE:
START SALARY:
END SALARY:
JOB TITLE:
SUPERVISOR:
SHIFT TYPE:
FULL TIME
PART TIME
TEMPORARY
ON CALL
IF PART TIME, HOW MANY HOURS A WEEK?
MAY WE CONTACT?
Yes
No
THIRD PREVIOUS EMPLOYER:
ADDRESS:
PHONE:
TOTAL TIME EMPLOYED:
DUTIES:
REASON FOR LEAVING:
START DATE:
END DATE:
START SALARY:
END SALARY:
JOB TITLE:
SUPERVISOR:
SHIFT TYPE:
FULL TIME
PART TIME
TEMPORARY
ON CALL
IF PART TIME, HOW MANY HOURS A WEEK?
MAY WE CONTACT?
Yes
No
PERSONAL REFERENCES: (Other than relatives)
FIRST REFERENCE NAME AND COMPLETE ADDRESS
BUSINESS OR AFFILIATION
TELEPHONE NUMBER(S)
YEARS KNOWN
SECOND REFERENCE NAME AND COMPLETE ADDRESS
BUSINESS OR AFFILIATION
TELEPHONE NUMBER(S)
YEARS KNOWN
THIRD REFERENCE NAME AND COMPLETE ADDRESS
BUSINESS OR AFFILIATION
TELEPHONE NUMBER(S)
YEARS KNOWN
Certification
(Required)
I agree to the following terms
I certify that the information contained in this application is true and complete. I understand that providing any false or misleading information, misrepresentation or willful omission of facts during the application or interview process may result in withdrawal from consideration for employment or my immediate discharge if already hired, regardless of when discovered. I authorize Bear Country U.S.A. to investigate all statements in this application and to conduct a thorough background investigation of my past including employment, education, credit and job related activities. I indemnify Bear Country U.S.A. against any liability which may result from conducting such investigation. All employers, educational institutions and references whether or not listed are hereby authorized to give Bear Country U.S.A. any and all information regarding my employment and character and are hereby released from any and all liability which may result from furnishing such information.
I understand that this application is not a contract of employment and that if hired, regardless of any oral representations to the contrary, the employment relationship between myself and Bear Country U.S.A. is terminable-at-will such that both the business and I remain free to choose to end our work relationship at any time for any or no reason. I understand my employment may be contingent upon my passing the health assessment (pre-work screening) relevant to the position applied for in this application or the position for which I may be selected and I agree to undergo that assessment. I understand that any possible health assessment will be conducted by a physician selected by Bear Country U.S.A. to determine whether I can perform the essential functions of the job. I further understand a drug or alcohol test may be required depending on the position for which I am hired, and I further understand that a positive result for a substance for which I do not have a then current legal prescription may result in withdrawal of any off or employment or immediate discharge if already hired.
I authorize Bear Country U.S.A. to supply information regarding my employment or character, in its sole discretion, in whole or in part, to any prospective employer, governmental agency, or other party with an interest which Bear Country U.S.A. deems appropriate and are hereby released from any and all liability which may result from furnishing such information.
I agree that any personal property carried by me to and from Bear Country U.S.A. premises may be inspected by Bear Country U.S.A. authorized personnel.
Applicant’s signature
Typed name acts as legal signature.
Today's Date
Month
Day
Year
Resume Attachment
Accepted file types: pdf, Max. file size: 128 MB.
71979
93618
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