Employment Application
Skills Unlimited, Inc.
Personal Information
First Name *
Your answer
Middle Initial
Your answer
Last Name *
Your answer
Maiden Name
Your answer
Social Security # *
Your answer
Current Street Address
Street/PO Box
Your answer
City or town, state, and ZIP code
Your answer
County
Your answer
Email Address
Your answer
Phone #:
Your answer
Are you 18 years of age or older? *
Referred by:
Your answer
What employment location are you applying for? *
Employment Desired
Position *
Status Desired *
Salary Desired
Your answer
Date you can start *
MM
/
DD
/
YYYY
Are you currently employed?
If you are currently employed, may we inquire of your present employer?
Have you ever applied to this company before?
Where?
When did you apply before?
Your answer
Are you related to a current Skills Unlimited Employee?
If you answered "yes" to the question above, what is the name of the current employee to which you are related?
Your answer
What hours are you available to work?
At Skills Unlimited, Inc. we have a variety of shifts available that run around the clock. Generally, our shifts from 7am-3pm, 3pm-11pm and 11pm-7am, though we also have many other shift variations. Please note below what days and what times you are available to work:
Monday
Your answer
Tuesday
Your answer
Wednesday
Your answer
Thursday
Your answer
Friday
Your answer
Saturday
Your answer
Sunday
Your answer
Comment on availability:
Your answer
Education
Where did you attend High School?
Your answer
How many years did you attend High School?
Your answer
Do you have a High School diploma or GED? *
Where did you attend College, Trade or Business School?
Your answer
How many years did you attend College, Trade or Business School?
Your answer
Did you graduate from College, Trade or Business School?
What subjects did you study?
English, Psychology, Math, etc...
Your answer
What degree or certificates did you earn?
Your answer
General
Do you have any special study, research or training skills in any subjects? If so, please explain:
Your answer
Please check any of the following training in which you are currently certified:
Do you have a current Driver's License?
Driver's License expiration date:
Your answer
Do you have current car insurance?
Car insurance expiration date:
Your answer
Have you ever been employed before?
Have you ever been convicted of a felony? *
Work History
Please list info on the last four employers, starting with the most recent.
Employer #1 (most recent)
#1 Dates worked (from Month/Year to Month/Year)
Example: 4/2011 to 3/2015
Your answer
#1 Name of Employer:
Your answer
#1 Employer Address
Your answer
#1 Employer Phone#
Your answer
#1 What was your position and what duties did you perform?
Your answer
#1 Salary
$10/hr
Your answer
#1 Reason for leaving:
Your answer
Employer #2
#2 Dates worked (from Month/Year to Month/Year)
Example: 4/2011 to 3/2015
Your answer
#2 Name of Employer:
Your answer
#2 Employer Address
Your answer
#2 Employer Phone#
Your answer
#2 What was your position and what duties did you perform?
Your answer
#2 Salary
$10/hr
Your answer
#2 Reason for leaving:
Your answer
Employer #3
#3 Dates worked (from Month/Year to Month/Year)
Example: 4/2011 to 3/2015
Your answer
#3 Name of Employer:
Your answer
#3 Employer Address
Your answer
#3 Employer Phone#
Your answer
#3 What was your position and what duties did you perform?
Your answer
#3 Salary
$10/hr
Your answer
#3 Reason for leaving:
Your answer
Employer #4
#4 Dates worked (from Month/Year to Month/Year)
Example: 4/2011 to 3/2015
Your answer
#4 Name of Employer:
Your answer
#4 Employer Address
Your answer
#4 Employer Phone#
Your answer
#4 What was your position and what duties did you perform?
Your answer
#4 Salary
$10/hr
Your answer
#4 Reason for leaving:
Your answer
#4 References
List three people, not related to you, whom you have known for at lest one year
1. Reference
Name, Address, Phone#, Business, Years Known
Your answer
2. Reference
Name, Address, Phone#, Business, Years Known
Your answer
3. Reference
Name, Address, Phone#, Business, Years Known
Your answer
About You
There are no wrong answers here. Much of our responsibilities here at Skills Unlimited, Inc. put us in constant interaction with other people. The more we know about you the better we can find a place where you may succeed.
On a scale of 1 to 5, how much experience do you have interacting with people who have learning, intellectual, developmental or physical disabilities?
None
Daily
Rate yourself on the following statements:
Always
Sometimes
Seldom
Never
I have to be up moving around.
I like small talk.
I like someone else telling me what to do.
I am the first to take action.
I use a daily planner.
I let other people's mood affect me.
I have to be out going places around town.
I like problems to solve.
I get lost in the details.
I am open about my feelings.
I am concerned for other people.
I take risks.
I am optimistic.
I like to work alone.
I like surprises.
What are your favorite activities?
Your answer
Pre-Screening Notice and Certification Request for the Work Opportunity Credit
The following questions are for form8850 - Pre-Screening Notice and Certification Request for the Work Opportunity Credit and will not be made available as items for employment screening at Skills Unlimited, Inc.
If you are under age 40, enter your date of birth (month, day, year)
MM
/
DD
/
YYYY
Place an X below if you received a conditional certificate from the state workforce agency (SWA) or a participating local agency for the work opportunity credit.
Your answer
Read the following statements and place an X in the space below if any of them apply to you.
Your answer
- I am a member of a family that has received assistance from Temporary Assistance for Needy Families (TANF) for any 9 months during the past 18 months.

- I am a veteran and a member of a family that received Supplemental Nutrition Assistance Program (SNAP) benefits (food stamps) for at least a 3-month period during the past 15 months.

- I was referred here by a rehabilitation agency approved by the state, an employment network under the Ticket to Work program, or the Department of Veterans Affairs.

- I am at least age 18 bot not age 40 or older and I am a member of a family that:
a. Received SNAP benefits (food stamps) for the past 6 months, or
b. Received SNAP benefits (food stamps) for at least 3 of the past 5 months, but is not longer eligible to receive them.

- During the past year, I was convicted of a felony or released from prison for a felony.

- I received supplemental security income (SSI) benefits for any month ending during the past 60 days.

- I am a veteran and I was unemployed for a period or periods totaling at least 4 weeks but less than 6 months during the past year.

Place an X below if you are a veteran and you were unemployed for a period or periods totaling at least 6 months during the past year.
Your answer
Place an X below if you are a veteran entitled to compensation for a service-connected disability and you were discharged or released from active duty in the U.S. Armed Forces during the past year.
Your answer
Place an X below if you are a veteran entitled to compensation for a service-connected disability and you were unemployed for a period or periods totaling at least 6 months.
Your answer
Read the following statements below and place an X in the space below if any of them apply to you.
Your answer
- Received TANF payments for at least the past 18 months, or

- Received TANF payments for any 18 months beginning after August 5, 1997, and the earliest 18-month period beginning after August 5, 1997, ended during the past 2 years, or

- Stopped being eligible for TANF payments during the past 2 years because federal or state law limited the maximum time those payments could be made.

Signature
Check one of the choices below
By typing my name in the space provided below, I understand that I am signing this application.
Sign by Typing Name Below
Your answer
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