Application for Employment

USH Application for Employment

Personal Information
Today's Date:
Name:*
First Middle Last
Address:*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Home Phone:*
Mobile Phone:*
Email:*
Are you under the age of 18?*
- yes
- no
Do you possess a valid work permit?*
- yes
- no
Last 4 digits of your social security number:*
Are you currently authorized to work in the United States?*
Proof of eligibility will be required if hired
- yes
- no
Have you ever been employed by USHydrations, formerly Nature's Way Purewater?*
- yes
- no
What was the start date of your last employment with us?*
MM slash DD slash YYYY
What was the end date of your last employment with us?*
MM slash DD slash YYYY
Are you related to anyone currently employed by us?*
- yes
- no
Who are you related to?*
First Last
How are you related?*
Position you are applying for:*
How did you hear about this opportunity?*
Who made you aware of this opening?*
First Last
Desired Annual Salary:*
When are you available to be begin work?*
MM slash DD slash YYYY
What type of position are you interested in?*
check all that apply
- Full time
- Part time
- Temporary/Seasonal
What best describes your availability to work?*
Occasional overtime and weekends will be mandated and required
What days can you work?*
Check all that apply
- Monday
- Tuesday
- Wednesday
- Thursday
- Friday
- Saturday
- Sunday
What time can you start Monday?
What time do you need to stop Monday?
What time can you start Tuesday?
What time do you need to stop Tuesday?
What time can you start Wednesday?
What time do you need to stop Wednesday?
What time can you start Thursday?
What time do you need to stop Thursday?
What time can you start Friday?
What time do you need to stop Friday?
What time can you start Saturday?
What time do you need to stop Saturday?
What time can you start Sunday?
What time do you need to stop Sunday?
Have you ever been assigned to work at USHydrations, formerly Nature's Way Purewater through a staffing agency?*
- yes
- no
What was the agency's name?*
When did your assignment start?*
MM slash DD slash YYYY
When did your assignment end?*
MM slash DD slash YYYY
What type of work did you perform during your assignment?*
Have you ever signed a non-compete of confidentiality agreement prohibiting you from accepting employment with a company like USHydrations?*
- yes
- no
Explain the terms of the agreement:*
Today do you have an active Pennsylvania driver's license in good standing?*
- yes
- no
Can you explain the reason for your license standing?*
Do you have any moving violations, accidents, or were your driving privileges suspended during the past 3 years?*
- yes
- no
Can you explain the violations, accidents, and/or suspension?*
In the last seven (7) years have you been charged or convicted of ANY misdemeanors or felonies?*
- yes
- no
Are these charges or convictions substantially related to the functions of the position for which you are applying?*
- yes
- no
What was the date of the conviction?*
MM slash DD slash YYYY
What was the nature of the offense?*
Where did the conviction occur?*
What was the disposition of the case?*
Military Experience
Have you ever been an enlisted member of the United States armed forces?*
- yes
- no
What branch did you serve in?*
Please list any relevant skills/work experience you acquired during your military service:*
Employment History
Please list your present or most recent job first and include all employment experiences in the past seven (7) years.
Most recent employer:*
Company phone:*
Job Title:*
Start date of employment:*
MM slash DD slash YYYY
End date of employment:*
MM slash DD slash YYYY
Supervisor:*
What was your starting hourly rate?*
What was your final hourly rate?*
Reason for leaving:*
Please be specific
May we contact this employer?*
- yes
- no
Are you able to provide information for a second employer?
Second most recent employer:*
Company phone:*
Job Title:*
Start date of employment:*
MM slash DD slash YYYY
End date of employment:*
MM slash DD slash YYYY
Supervisor:*
What was your starting hourly rate?*
What was your final hourly rate?*
Reason for leaving:*
Please be specific
May we contact this employer?*
- yes
- no
Are you able to provide information for a third employer?
3rd Most recent employer:*
Company phone:*
Job Title:*
Start date of employment:*
MM slash DD slash YYYY
End date of employment:*
MM slash DD slash YYYY
Supervisor:*
What was your starting hourly rate?*
What was your final hourly rate?*
Reason for leaving:*
Please be specific
May we contact this employer?*
- yes
- no
Other experience and qualifications:*
Please use this space to elaborate on your background, experience or qualifications that you believe should be considered in evaluating your qualifications for employment.
Educational background
What kind of educational background do you have?*
- No GED or High School Diploma
- GED
- High school
- College
- Trade school
Check all that apply
Name & location of school you received your GED from:*
Number of years completed:*
Did you graduate?*
- yes
- no
Degree/Diploma Type:*
Where did you attend high school?*
Number of years completed:*
Did you graduate?*
- yes
- no
Degree/Diploma Type:*
Where did you attend college?*
How many years of college did you complete?*
Did you graduate?*
- yes
- no
What type of degree(s) do you have?*
Name & location of trade school:*
Number of years completed:*
Did you graduate?*
- yes
- no
Degree/Diploma Type:*
References
Please list two (2) professional references and one (1) personal reference other than a relative.
1st Reference:*
First Last
Company & Position:*
Phone:*
Years known:*
Second Reference:*
First Last
Company & Position:*
Phone:*
Years known:*
Third reference:*
First Last
Relationship:*
Phone:*
Years known:*
Resume Upload:
Accepted file types: pdf, , Max. file size: 56 MB.
Acknowledgement
PLEASE READ CAREFULLY

We are an EEO employer. USHydrations adheres to a policy of making employment decisions without regard to race, color, religion, gender, sexual orientation, national origin, citizenship, age or disability.

APPLICATION ACKNOWLEDGEMENT

I submit this application freely and willingly as a gesture of my interest in employment. I declare the information I provided herein is true, complete and represents an accurate statement of facts. If hired, I agree to abide by all policies and rules whether written, verbal or otherwise during my course of employment. If selected I will be employed on an “at will” basis and either I or my employer will have the right to end our employment relationship at any time with or without notice or for any or no reason whatsoever. I understand USHydrations has a drug free workplace and reserves the right to conduct pre-employment and random drug testing if I am hired. I understand any offer of employment or continued employment is not guaranteed for any length of time. I authorize an investigation of all statements contained in this application now and during the course of my employment. I understand that any misrepresentation or omission of facts is cause for dismissal at any time without any previous notice. Any corrections I wish to make to the information included herein must be submitted in writing. I hereby give USHydrations or their assigns full permission to contact schools, all previous employers (unless otherwise indicated), references and others and hereby release the Company from any liability as a result of such contract or references on my behalf.
Digital Signature:*
The boxes below represent your digital signature, and by typing your name within them you acknowledge and agree with the above statements.
First Last
Today's Date:

Application for Employment

USH Application for Employment

Personal Information

Military Experience

Employment History

Educational background

References

Acknowledgement