Max I. Walker - Omaha Dry Cleaning and Laundering

Application for Employment

Equal access to programs, services and employment is available to all persons. Those applicants requiring reasonable accommodation to the application and/or interview process should notify a representative of the Human Resources Department.

Position(s) Applied For		Date of Application
Desired Work Location
Name
Street Address		Apt. No./Suite No.
City	State	Zipcode
Telephone	Mobile/Beeper/Other
E-Mail Address

If you are under 18, and it is required, can you furnish a work permit?	Yes	No
If no, please explain

Have you ever been employed here before?	Yes	No
If yes, give dates and positions

Are you legally eligible for employment in this country?	Yes	No
Date Available for Work

Type of Employment Desired	Full-Time	Part-Time	Temporary
	Seasonal	Educational Co-Op
Are you able to meet the attendance requirements of the position?		Yes	No

Have you ever pled "guilty" or "no contest" to, or been convicted of a crime?	Yes No
If yes, please provide date(s) and details (answering "yes" to these questions does not constitute and automatic bar to employment. Factors such as date of the offense, seriousness and nature of the violation, rehabilitation and position applied for will be taken into account)

Driver's license number if driving is an essential job function	State

Employment History

Provide the following information of your past four(4) employers, assignments or volunteer activities, starting with the most recent

Employer		From	To
Address
Immediate Supervisor and Title
Telephone Number	May we contact for reference? Yes No Later
Hourly Rate/Salary Start Per Hour Year Final Per Hour Year
Summarize the nature of work performed and job responsibilities

Reason for Leaving

Employer		From	To
Address
Immediate Supervisor and Title
Telephone Number	May we contact for reference? Yes No Later
Hourly Rate/Salary Start Per Hour Year Final Per Hour Year
Summarize the nature of work performed and job responsibilities

Reason for Leaving

Employer		From	To
Address
Immediate Supervisor and Title
Telephone Number	May we contact for reference? Yes No Later
Hourly Rate/Salary Start Per Hour Year Final Per Hour Year
Summarize the nature of work performed and job responsibilities

Reason for Leaving

Employer		From	To
Address
Immediate Supervisor and Title
Telephone Number	May we contact for reference? Yes No Later
Hourly Rate/Salary Start Per Hour Year Final Per Hour Year
Summarize the nature of work performed and job responsibilities

Reason for Leaving

Skills and Qualifications

Summarize any training, skills, licenses and/or certificates that may qualify you as being able to perform job related functions in the position for which you are applying.

Educational Background

(if job related)

High School	Location
Number of Years Completed	Did You Graduate? Yes No
Course of Study
College	Location
Number of Years Completed	Did You Graduate? Yes No
Major	Degree
Course of Study
Other	Location
Number of Years Completed	Did You Graduate? Yes No
Major	Degree
Course of Study

References

Name	Telephone	Number of Years Known
Name	Telephone	Number of Years Known
Name	Telephone	Number of Years Known

Post Your Resume (Optional)

Copy and paste the text of your resume in the field below

Applicant Statement

I certify that all information I have provided in order to apply for and secure work with the employer is true, complete and correct.

I understand that any information provided by me that is found to be false, incomplete or misrepresented in any respect, will be sufficient cause to (i) cancel further consideration of this application, or (ii) immediately discharge me from the employer's service, whenever it is discovered.

I expressly authorize, without reservation, the employer, its representatives, employees or agent to contact and obtain information from all references (personal and professional), employers, public agencies, licensing authorities and educational institutions and to otherwise verify the accuracy of all information provided by me in the application, resume or job interview. I hereby waive any and all rights and claims I may have regarding the employer, its agents, employees or representatives, for seeking, gathering and using such information in the employment process and all other persons, corporations or organizations for furnishing such information about me.

I understand that the employer does not unlawfully discriminate in employment and no question on this application is used for the purpose of limiting or excusing any applicant from consideration for employment on a basis prohibited by applicable local, state or federal law.

I understand that this application remains current for only 30 days. At the conclusion of that time, if I have not heard from the employer and still wish to be considered for employment, it will be necessary to reapply and fill out a new application.

If I am hired, I understand that I am free to resign at any time, with or without cause and without prior notice, and the employer reserves the same right to terminate my employment at any time, with or without cause and without prior notice, except as may be required by law. This application does not constitute an agreement or contract for employment for any specified period or definite duration. I understand that no supervisor or representative of the employer is authorized to make any assurances to the contrary and that no implied, oral or written agreements contrary to the foregoing express language are valid unless they are in writing and signed by the employer's president.

I also understand that if I am hired, I will be required to provide proof of identity and legal authority to work in the United States and that federal immigration laws require me to complete an I-9 Form in this regard.

I understand that I may be asked to take a test to help asses my suitability for the job for which I am applying.

By pressing the "Submit Application Button Below", you certify that you have read, fully understand and accept all terms of the foregoing Application Statement.