Employment Application
SKILLS, Inc., is an equal opportunity employer and prohibits discrimination against otherwise qualifies applicants on the basis of the individual's status in a protected class. Protected classes include race, color, religion, sex, age, national origin, genetic information, legally recognized disability, military services or veteran status, creed, gender identity, sexual orientation, pregnancy, marital or civil union status, citizenship, ancestry, ethnic heritage, or any other status protected under local, state, or federal laws.
Email *
PERSONAL
Date *
MM
/
DD
/
YYYY
Last *
First *
Middle
Phone Number *
Physical Address *
Mailing Address if different
Position Sought *
Desired Employment *
How did you hear of this position *
Date Available *
MM
/
DD
/
YYYY
Hourly Wage Desired
Are you 18 years or older *
If not, can you supply a work permit
Clear selection
Are you legally eligible for employment in the United States (if offered employment, you will be requires to provide documentation to verify eligibility
Clear selection
Please indicate if you have resided in any other state(s) or country(s)
Do you have dependable transportation
Clear selection
A valid Driver's license *
How many hours a week are you seeking?
What shift can you work (check all that apply
What days can you work (check all that apply) *
Required
Will you work overtime if asked? *
EDUCATION
Please indicate education or training which you believe qualifies you for the position you are seeking High School-Number of years completed (Check one)
Clear selection
Diploma? *
G.E.D?
Clear selection
Name of School
City/State *
College and/or Vocational School-Number of years completed
Clear selection
Name of School
City/State
Major
Degree(s) Earned
Other Special Training (i.e., CRMA, CPR/First Aid, DSP) Course
Degree/Certificate Earned
Course
Degree/Certificate Earned
Other Skills
PROFESSIONAL LICENSE OR MEMBERSHIP Type of License(s) held
License Number
Expiration Date
MM
/
DD
/
YYYY
Other professional membership(s)
(Please do not disclose membership or affiliations that are not specific to your profession and/or which may reveal protected status information)
RECORD OF CONVICTION
(A conviction will not necessarily automatically disqualify you for employment. Rather, such factors as age and date of conviction, seriousness and nature of the crime and rehabilitation will be considered.)

Have you ever been convicted of:
Felony? *
Misdemeanor? *
Substantiation of abuse/neglect/exploitation of a child or adult? *
Assault? *
OUI? *
If you answered YES to any charge, please explain:
If you have any pending charges, please explain:
Have you ever been employed in any facility of SKILLS, Inc., including Ken-A-Set Assoc. or Sebasticook Farms?
Clear selection
If yes, please describe
May we contact you present employer? *
EMPLOYMENT (List most recent employer first, including U.S. Military service
Employer
Address
Telephone
Position
Dates of employment: From-To
Supervisor
Department
Duties
Amount of average hours
Reason for Leaving
Employer
Address
Telephone
Position
Date of Employment: From-To
Supervisor
Department
Duties
Average amount of hours
Reason for Leaving
Employer
Address
Telephone
Position
Dates of Employment: From-To
Supervisor
Department
Duties
Average amount of hours
Reason for Leaving
If you wish to describe additional work experience, please include the above information for each position on a separate sheet of paper.
Explain any gaps in work history
REFERENCES
(Please provide (2) Professional and (2) Personal (non-relative or employer) References)
Professional
Name
Address
Telephone
Name
Address
Telephone
Personal (non-relative or employer)
Name
Address
Telephone
Name
Address
Telephone
Applicant Certification
The information provided by me in this Application for Employment is true, correct, and complete. If employed, I understand that any untrue, misleading, misstatement or omission of fact on this Application or during the hiring process may result in my dismissal. *
I understand that receipt of this Application does not imply that I will be employed. If employed, I understand and agree that such employment will not be governed by any expressed or implied contract, but is at-will. I understand and agree that no representative of SKILLS, Inc., has the authority to make any assurance to the contrary. Either SKILLS, Inc., or I may terminate the employment relationship at any time, with or without notice for any lawful reason. *
I authorize SKILLS, Inc., to communicate with my prior and current employers, school officials, government agencies, and persons named as references concerning my employment performance and history, and my skills, character and responsibility. I hereby release and hold harmless all parties involved from any/all liability for any damage whatsoever resulting from giving information such as work performance, character, and reputation. I further understand that if I do not give permission to contact my current employer, my application may be automatically rejected. *
I understand that if offered a position with SKILLS, Inc., I will be required to submit to a pre-employment background check which may include a criminal background check, child/adult protective services background check, sexual predator history check, driver’s license check, medical examination, and any other checks required by laws, regulations, contracts, etc. I understand that these checks may be re-run at the discretion of SKILLS, Inc., throughout the term of my employment. I understand that unsatisfactory results from, refusal to cooperate with, or any attempt to affect the results of these requirements will result in withdrawal of any employment offer or termination of employment. *
I understand that should an employment offer be extended to me and accepted, I will fully adhere to the policies, procedures, rules and regulations of employment of SKILLS, Inc. I understand specifically that mandatory trainings, attendance and punctuality are essential requirements of my job and non-compliance may result in disciplinary action up to and including termination. *
Type your full name to indicate agreement with the above terms and to electronically sign this employment application *
Date of Signature *
MM
/
DD
/
YYYY
Submit
Never submit passwords through Google Forms.
This form was created inside of Skills inc. Report Abuse