Name *

First Name

Last Name

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone *

(###)

###

####

How did you hear about Casper Company? *

Employment Agency

State Employment Office

College Placement Service

Friend

Walk-in

Other

If hired, can you show proof of your identify and legal authorization to work in the United States? *

Yes

No

Date you can start *

MM

DD

YYYY

Are you employed now? *

Yes

No

If yes, may we contact your employer?

Yes

No

Have you applied at Casper Company before? *

Yes

No

Did you graduate from high school? *

Yes

No

Did you graduate from college?

Yes

No

Did you graduate from the program?

Yes

No

Do you have any of the following (check all that apply) *

Class A Driver's License

Class B Driver's License

Hazmat certificate

Other certificate (explain below)

None of the above

Reference 1 - Phone *

(###)

###

####

Reference 1 - Is this a personal or business contact? *

Personal

Business

Reference 2 - Phone *

(###)

###

####

Reference 2 - Is this a personal or business contact? *

Personal

Business

Reference 3 - Phone *

(###)

###

####

Reference 3 - Is this a personal or business contact? *

Personal

Business

Present or Most Recent Employer: Company Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Present or Most Recent Employer: May we contact your supervisor? *

Yes

No

Present or Most Recent Employer: Supervisor Phone Number *

(###)

###

####

Previous Employer 2: Company Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Previous Employer 2: May we contact your supervisor?

Yes

No

Previous Employer 2: Supervisor's Phone Number

(###)

###

####

Previous Employer 3: Company Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Previous Employer 3: May we contact your supervisor?

Yes

No

Previous Employer 3: Supervisor Phone Number

(###)

###

####

Applicant's Electronic Signature - Please read before signing. *

I authorize any persons or organizations named in this application to give you complete information and records regarding my employment, education, character and qualifications, including driving and background. I certify that all answers and statements I have made on this application (and resume or other supplementary materials) are true and complete without omissions. I understand that misrepresentation or omissions of facts called for shall be grounds for rejection of this application or for termination. I understand and agree that my employment if offered, is for no definite period and may be terminated at any time without any prior notice, regardless of the date of payment of my wages and salary. I further understand that, although I may be terminated for cause, no cause or reason is required for termination. I also understand that this "at-will" employment relationship may not be changed or altered by anyone within the company except the President, and even then such change is valid only if written and signed by the President.

First Name

Last Name