Please fill out the employment application below. It is the policy of Step Saver to provide equal employment opportunities to all applicants and employees without regard to any legally protected status such as race, color, religion, gender, national origin, age, disability or veteran status.
Who should be contacted if you are involved in an emergency?
Contact Name:
Relationship to you:
Address:
City, State, Zip:
Daytime phone:
Evening phone:
Position for which
you are applying:
Salary desired:
Referral Source:
Who referred you to Step Saver?
Have you applied at Step Saver previously?
Yes No
If yes, when?
Are you at least 18 years old?
Yes No
How will you get to work?
Driver's licence number including state from which it was issued:
Available hours:
Are you willing to work any shift, including nights and weekends?
Yes No
If no, list limitations:
If hired, when can you start work?
Step Saver Employement Requirements:
Are you legally eligible to work in the United States?
Yes No
Are you able to perform the essential functions of the job position with or without reasonable accommodation?
Yes No
If no, list limitations:
Have you ever been convicted of a crime, including traffic violations?
Yes No
If yes, please describe:
The existence of a criminal record DOES NOT constitute an automatic bar to employment unless relevant to the type of employment.
Previous Employment History
List your current or or most recent employment first
Employer Name:
Address:
City, State, Zip:
Job duties:
Reason for leaving:
Dates of employment (month / year):
Employer Name:
Address:
City, State, Zip:
Job duties:
Reason for leaving:
Dates of employment (month / year):
Employer Name:
Address:
City, State, Zip:
Job duties:
Reason for leaving:
Dates of employment (month / year):
Education and References
High School name and address:
Last grade completed:
9
10
11
12
Diploma:
yes
no
College name and address:
Did you receive a degree?
yes
no
Other training (graduate, technical, vocational:
Awards, honors, special achievements:
Related Skills: List any skills that may be useful for the job you are seeking. Enter the number of years of experience, and select the number which corresponds to your ability for each particular skill. (One represents poor ability, while five represents exceptional ability.)
1 2 3 4 5
1 2 3 4 5
References: List two people who would be willing to provide a reference for you:
Name:
Address:
City, State, Zip:
Telephone:
Relationship:
Name:
Address:
City, State, Zip:
Telephone:
Relationship:
Please provide any other information that you feel should be considered:
Certification:
I certify that the information provided on this Application is truthful and accurate. I understand that providing false or misleading information will be the basis for rejection of my Application, or if employment commences, immediate termination.
I authorize Utah Step Saver to contact former employers and educational organizations regarding my employment and education. I authorize my former employers and educational organizations to fully and freely communicate information regarding my previous employment, attendance, and grades. I authorize those persons designated as references to fully and freely communicate information regarding my previous employment and education.
If an employment relationship is created, I understand that unless I am offered a specific written contract of employment signed on behalf of the organization by its Manager, the employment relationship will be entirely voluntary in nature. In other words, with appropriate notice, I will have the full and complete discretion to end the employment relationship when I choose and for reasons of my choice. Similarly, my employer would have the same right. Moreover, no agent, representative, or employee of Utah Step Saver, except in a specific written contract of employment signed on behalf of the organization by its Manager, has the power to alter or vary the voluntary nature of the employment relationship.
I HAVE CAREFULLY READ THE ABOVE CERTIFICATION AND I UNDERSTAND AND AGREE TO ITS TERMS.
Thank you for taking the time to complete this application.
