Job Application Form Crunch Pak300 Sunset Highway, Cashmere, WA 98815[email protected] Step 1 of 2 50% **If you are having problems submitting your resume, please email a copy to: [email protected]CRUNCH PAK IS AN EQUAL OPPORTUNITY/AFFIRMATIVE ACTION EMPLOYER AND FULLY COMPLIES WITH APPLICABLE FEDERAL, STATE AND/OR LOCAL LAWS, ORDERS AND REGULATIONS.PERSONAL INFORMATIONDate(Required) MM slash DD slash YYYY First Name(Required)Middle NameLast Name(Required)Email Address(Required) Address(Required) Street Address Address Line 2 City State AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code Phone Number(Required)ARE YOU UNDER 18 YEARS OLD?(Required) Yes No WILL YOU WORK OVERTIME?(Required) Yes No ARE YOU LEGALLY AUTHORIZED TO WORK IN THE U.S.?(Required)I also understand that if I am hired, I will be required to provide proof of identity and legal authorization to work in the United States and that federal immigration laws require me to complete I9 form in this regard. Yes No IF NO PLEASE EXPLAIN EMPLOYMENT DESIREDPOSITION(Required)DATE YOU CAN START(Required) MM slash DD slash YYYY WAGE DESIREDEVER WORKED FOR THIS COMPANY BEFORE?(Required) Yes No WHEN? MM slash DD slash YYYY ARE YOU ABLE TO PERFORM THE ESSENTIAL FUNCTIONS OF THE JOB FOR WHICH YOU ARE APPLYING (with our without reasonable accommodation)? The minimum job requirements are included in the job description.(Required) Yes No REFERRED BY (if applicable)EDUCATIONNAME AND LOCATION OF SCHOOLNO. OF YEARS ATTENDEDDID YOU GRADUATE? Yes No SUBJECTS STUDIED+ Add additional education Yes No NAME AND LOCATION OF SCHOOLNO. OF YEARS ATTENDEDDID YOU GRADUATE? Yes No SUBJECTS STUDIED+ Add additional education Yes No NAME AND LOCATION OF SCHOOLNO. OF YEARS ATTENDEDDID YOU GRADUATE? Yes No SUBJECTS STUDIEDThe Age Discrimination in Employment Act of 1987 prohibits discrimination on the basis of age with respect to individuals who are at least 40 years of age.U.S MILITARY OR NAVAL SERVICE (if applicable)SPECIAL EDUCATION OR TRAINING (if applicable)EMPLOYMENT HISTORYPlease start with your most RECENT job and work BACKWARDS for the past 10 years.DO YO HAVE ANY GAPS IN YOUR EMPLOYMENT HISTORY?(Required) Yes No IF YES, PLEASE EXPLAIN:Employer’s Business NameEmployer’s address and phone numberContact Name and TitleMay we contact employer? Yes No From: (mm/dd/yy) MM slash DD slash YYYY To: (mm/dd/yy) MM slash DD slash YYYY Reason for LeavingDescribe the job duties and type of equipment or tools used or operated+ Add another employer Yes No Employer’s Business NameEmployer’s address and phone numberContact Name and TitleMay we contact employer? Yes No From: (mm/dd/yy) MM slash DD slash YYYY To: (mm/dd/yy) MM slash DD slash YYYY Reason for LeavingDescribe the job duties and type of equipment or tools used or operated+ Add another employer Yes No Employer’s Business NameEmployer’s address and phone numberContact Name and TitleMay we contact employer? Yes No From: (mm/dd/yy) MM slash DD slash YYYY To: (mm/dd/yy) MM slash DD slash YYYY Reason for LeavingDescribe the job duties and type of equipment or tools used or operatedRESUMEUpload your resumeMax. file size: 80 MB. IT IS CRUNCH PAK POLICY TO ACHIEVE AN ALCOHOL-FREE/DRUG-FREE ENVIRONMENT. THE DISPENSATION, POSSESSION, OR USE OF ALCOHOL OR ILLEGAL DRUGS WILL BE STRICTLY PROHIBITED IN THE WORKPLACE AND ON WORKTIME. “I CERTIFY THAT THE FACTS CONTAINED IN THIS APPLICATION ARE TRUE AND COMPLETE TO THE BEST OF MY KNOWLEDGE AND UNDERSTAND THAT, IF EMPLOYED, FALSIFIED STATEMENTS ON THIS APPLICATION SHALL BE GROUNDS FOR DISMISSAL. I AUTHORIZE INVESTIGATION OF ALL STATEMENTS CONTAINED HEREIN AND THE REFERENCES LISTED ABOVE TO GIVE YOU ANY AND ALL INFORMATION CONCERNING MY PREVIOUS EMPLOYMENT AND ANY PERTINENT INFORMATION THEY MAY HAVE, AND RELEASE ALL PARTIES FROM ALL LIABILITY FOR ANY DAMAGE THAT MAY RESULT FROM FURNISHING SAME TO YOU. I UNDERSTAND AND AGREE THAT, IF HIRED, MY EMPLOYMENT IS FOR NO DEFINITE PERIOD AND MAY, REGARDLESS OF THE DATE OF PAYMENT OF MY WAGES AND SALARY, BE TERMINATED AT ANY TIME WITHOUT PRIOR NOTICE AND WITHOUT CAUSE.”Signature(Required)Date(Required) MM slash DD slash YYYY CAPTCHA