Ball Employment Application

First Name*
Last Name*
Address*
Street Address Address Line 2 City State ZIP Code
Email*
Phone*
Date of Birth*
MM slash DD slash YYYY
Social Security Number (last 4 digits)*
Emergency Contact*
Emergency Contact Phone*
Relationship*
Marital Status*
- Single
- Married
- Divorced
Work Authorization*
Please Explain
Name of any relatives currently employed by the company
Referred by
Employment Type*
Position Desired*
Rate of pay desired*
Please attach your resume
Max. file size: 5 MB.
WORK INFORMATION
Have you ever worked for this company before?
- Check box for "YES"
Are you currently employed?
- Check box for "YES"
How long have you been unemployed?
Physical History
List any physical limitations
Have you ever been injured on the job?*
- Yes
- No
Please list the nature of the injury(s)*
How much time have you lost from work in the past year from illness?
Have you ever received worker's compensation?*
- Yes
- No
Workers comp start date:*
MM slash DD slash YYYY
Workers comp end date:*
MM slash DD slash YYYY
MILITARY STATUS
Have you ever been in the U.S. Armed Forces?*
- Yes
- No
Military Branch*
Rank at time of discharge*
Date of Discharge*
MM slash DD slash YYYY
Education
Education Level*
Last School Attended*
Have you ever been convicted of a felony?*
- Yes
- No
Date of conviction*
MM slash DD slash YYYY
Please explain*
WORK HISTORY
Please provide your most recent work history first
Former Employer*
Former Employer Phone*
Position*
Supervisor*
Date Employed From*
MM slash DD slash YYYY
Date Employed To*
MM slash DD slash YYYY
Reason for leaving*
Former Employer 2
Former Employer 2 Phone
Position
Supervisor
Date Employed From
MM slash DD slash YYYY
Date Employed To
MM slash DD slash YYYY
Reason for leaving
Certification*
- I hereby certify that I have not knowingly withheld any information that might adversely affect my chances for employment and that the answers given by me are true and true to the best of my knowledge. I further certify that the undersigned applicant, have personally completed this application. I understand that any omission or misstatement of material fact on this application or on any document used to secure employment shall be grounds for rejection of this application or for immediate discharge if I am employed regardless of time elapsed before discovery.
Background Check*
- I hereby authorize the company to thoroughly investigate my references, work record, education and other matters related to my suitability for employment and further authorize the references I have listed to disclose to the company any and all letters, reports and other information related to my work records, without giving my prior notice to such disclosure. In addition, I hereby release the company, my former employers and all other persons, corporations, partnerships and associations from any and all claims, demands, or liabilities arising out of or in any way to such investigation or disclosure.
Arbitration*
- I hereby agree to submit binding arbitration all disputes and claims arising out of the submission of this application. I further agree, in the event that I am hired by the company, that all disputes that cannot be resolved by informal internal resolution, which might arise out of my employment, will be submitted to binding arbitration. I agree that such arbitration shall be conducted under the rules of the American Association of Arbitration. This application contains the entire agreement between the parties with regard to dispute resolution, and there are no other agreements as to dispute resolution either oral or written.
At Will Employment*
- I understand that nothing contained in the application, or conveyed during any interview, which may be granted, or during my employment if hired, is intended to create an employment contract between the company and me. In addition I understand and agree that if I am employed my employment is for no definite or determinable period and may be terminated at any time with or representations contrary to the foregoing are binding on the company unless made in writing and signed by me and the company’s designated representative.
Misrepresentation*
- I agree and understand that any misrepresentation of information given above shall be considered an act of falsification. I agree and understand that the employment is factual. I agree and understand that if hired, I will be on a probationary period during which time I may be discharged without recourse.
Signature*
Please type your name to the left as this represents your digital signature. By signing this you are stating that all information submitted on this form is true and accurate.

Ball & Chain Employment Application

WORK INFORMATION

Physical History

MILITARY STATUS

Education

WORK HISTORY

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