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Employment Application
1
About You
2
Employment Information
Applicant Information
Your Name
(Required)
First
Last
Date of Birth
(Required)
MM slash DD slash YYYY
Address
(Required)
Street Address
Address Line 2
City
State
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
ZIP Code
Email
(Required)
Phone
(Required)
Position Information
Date Available
(Required)
MM slash DD slash YYYY
Desired Salary
Position You're Applying For
(Required)
Driver
Day Warehouse
Night Warehouse
Meat Room
Chicken Room
Produce Repack
Other
Other - Please Specify
(Required)
Have you ever worked for Merit Foods?
(Required)
Yes
No
When did you last work for Merit Foods?
(Required)
MM slash DD slash YYYY
Supervisor's Name
(Required)
First
Last
Are you a citizen of the United States?
(Required)
Yes
No
Are you authorized to work in the United States?
(Required)
Yes
No
Have you ever been convicted of a felony?
(Required)
Yes
No
Please explain
(Required)
Education
High School Name
(Required)
City, State
(Required)
Dates of Attendance
(Required)
Did you graduate?
(Required)
Yes
No
Diploma
College/Trade School Name
City, State
Dates of Attendance
Did you graduate?
Yes
No
Degree
Driving History
Do you have a clean driving record?
(Required)
Yes
No
Please list any incidents or citations
(Required)
Date
City/State of Incident
Citation/Fine Amount
Add
Remove
Military Service
Have you served in the military?
(Required)
Yes
No
Do not wish to answer
Branch
Dates of Service
MM slash DD slash YYYY
Rank at Discharge
Type of Discharge
If other than honorable, please explain
Previous Employment
Company 1
Company Name
(Required)
City/State
(Required)
Phone Number
Dates of Employment
(Required)
Position Held
(Required)
Responsibilities
(Required)
Reason for Leaving
(Required)
Supervisor Name
(Required)
May we contact for reference?
(Required)
Yes
No
Please explain
(Required)
Company 2
Company Name
(Required)
City/State
(Required)
Phone Number
Dates of Employment
(Required)
Position Held
(Required)
Responsibilities
(Required)
Reason for Leaving
(Required)
Supervisor Name
(Required)
May we contact for reference?
(Required)
Yes
No
Please explain
(Required)
Company 3
Company Name
(Required)
City/State
(Required)
Phone Number
Dates of Employment
(Required)
Position Held
(Required)
Responsibilities
(Required)
Reason for Leaving
(Required)
Supervisor Name
(Required)
May we contact for reference?
(Required)
Yes
No
Please explain
(Required)
References
References
(Required)
Please list at least three references.
Name
Phone Number
Relationship
Add
Remove
Disclaimer and Signature
Signature
(Required)
I certify that my answers are true and complete to the best of my knowledge. If this application leads to employment, I understand that false or misleading information in my application or interview may result in termination of employment.
Date
(Required)
MM slash DD slash YYYY
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