Employment

Employment

APPLICATION FOR EMPLOYMENT
Human Resources Division, 900 Jefferson Road Bldg.11 Rochester, New York 14623
Office: (716) 292-6642 FAX: (716) 292-1591
AN EQUAL OPPORTUNITY EMPLOYER: Cavco Services Inc. promotes work place diversity.
PLEASE COMPLETE EACH SECTION OF THIS APPLICATION

Position for which you are applying:

How did you learn of this opening?

Format:00-00-00
Date you could start:

$
Rate desired:

NAME:

Last

First

Middle

ADDRESS:

Street

City

State

Zip Code

PHONE:Format:000-000-0000

Home

Work

Pager

Cell

Social Security # :

Are you over 21? Yes No

· For the purpose of compliance with the United States Immigration and Nationalization Act are you legally eligible for employment in the United States?
Yes No

· Were you previously employed by Cavco Services Inc.? If so, please provide employment dates, position title and department

· Have you ever been convicted of a felony or misdemeanor, other than minor traffic violations?
Yes No (If yes, explain )

· Do you have a valid driver’s license? Yes No

License Number/State/ExpirationDate / /

· Have you ever been fired or resigned from a position after being notified you would be fired?
Yes No (If yes, explain)

· Please select the boxes that correspond to the evenings that you are available to work.
M Tu W Th F Sa Su

· Can you read and understand instructions written in English? Yes No

· Do you have dependable transportation of your own.? Yes No
( Bus transportation does not qualify)

· Are you related to anyone employed by Cavco Services Inc? Yes No
If yes , who?

· Do you have prior cleaning experience? Yes No
If yes, details:

References: Please give the names of 3 persons NOT related to you, whom you have known at least one year:
1. Name: Years known:

Tel#: Occupation:

2. Name: Years known:

Tel#: Occupation:

3. Name: Years known:

Tel#: Occupation:

Present Employer:
Address:

Name of Supervisor: Tel#:
May we contact this employer? Yes No

Day job start time: AM PM Day job finish time: AM PM

PHYSICAL RECORD: Do you have any impairment that would interfere with your ability to perform the job for which you have applied?

Are you currently receiving any disability benefits? Yes No If yes please give details:

Please name another adult living at your residence that we may contact in case of emergency:
Name: Relationship to you:

ADDITIONAL EMERGENCY NUMBER (other than at your home):
Name: Relationship to you: Tel# :

	Name & Location	Date		Degree or # Of Credits Completed	Date Graduated	Major Area of Study
	Name & Location	From	To	Degree or # Of Credits Completed	Date Graduated	Major Area of Study
High School Or Highest Grade Completed
College or University
Graduate School
Business or Trade School

· If you expect to complete an educational program in the near future, please indicate what type of degree and when you expect to receive it:

· List below present and past employment, beginning with the most recent. Include any related military service or volunteer work.

1: Name of Employer Address/Telephone# Position held Dates of employment Supervisor

2:

3:

4:

5:

I certify that the statements in this application are true and complete to the best of my knowledge, and I agree that any intentional misstatement or omission will constitute grounds for unfavorable consideration of my application or dismissal from employment with Cavco Services Inc.

I authorize Cavco Services Inc. to obtain information from past employers and other sources to support the data on this application, including a review of my educational, criminal and credit records, as appropriate.

You may contact my PRESENT employer Yes No (If no, explain)

I understand and agree that my employment is for no definite period and may, regardless of the date of payment of my wages or salary, be terminated at any time without any previous notice

DATE:

 	 	 	 	 	 	          © Cavco Services Inc., 2007.