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Careers at Woodhouse

Woodhouse Application

Employment Application

Instructions
* Please answer all questions as completely as possible.
* Any field marked with an asterisk * is required, and the form will not submit without a value.
* After this form is submitted, you will have the opportunity to email your r�sum�.

Postion / Department Applying For

Full Time

Part Time

Either

Personal Information

First Name *	Last Name *	Email Address *

Address (line 1) *	Address (line 2)

City *	State *	Zip Code *

Cell Phone	Home Phone *

About Your Position

What is your desired salary range? *

Preferred Location

Any

Blair

Omaha

Bellevue

Missouri Valley

What and/or Who Referred you to Woodhouse?

If you are under 18 and it is required,
can you furnish a work permit? *

Yes
No
n/a

If no, please explain

Have you ever been employed here before? *

Yes
No

If yes, please give date(s) and positions

Have you ever pleaded "guilty" or "no contest" to,
or been convicted of a crime? *

Yes
No

If yes, please provide date(s) and details

Are you legally eligible for employment in this country? *

YesNo

Please Check the Appropriate Response For Each Question

Are you furnished a company auto for your personal use? *	Yes	No
If so, will it be driven by anyone under 25 years of age?	Yes	No
Have you ever been denied a driver's license or had one suspended / revoked? *	Yes	No
Have you had any moving, traffic violations in the past 3 years? *	Yes	No
Have you had any auto accidents in the past 3 years? *	Yes	No

If the answer to any question was YES, please give date(s) and details

Work Experience (Most Recent First)

Employer Name

Job Title

Starting Date

Ending Date

Address (line 1)

Address (line 2)

City

State

Zip Code

Salary	Reason for Leaving	Job Functions

Manager Name

Telephone

May we contact them?

YesNo

Next Employer

Employer Name

Job Title

Starting Date

Ending Date

Address (line 1)

Address (line 2)

City

State

Zip Code

Salary	Reason for Leaving	Job Functions

Manager Name

Telephone

May we contact them?

YesNo

Next Employer

Employer Name

Job Title

Starting Date

Ending Date

Address (line 1)

Address (line 2)

City

State

Zip Code

Salary	Reason for Leaving	Job Functions

Manager Name

Telephone

May we contact them?

YesNo

Next Employer

Employer Name

Job Title

Starting Date

Ending Date

Address (line 1)

Address (line 2)

City

State

Zip Code

Salary	Reason for Leaving	Job Functions

Manager Name

Telephone

May we contact them?

YesNo

Your Skills

Please describe your skills *

Education

High School

Name	Years Completed	Did you Graduate		Course of Study
		Yes	No

College

Name	Years Completed	Did you Graduate		Course of Study
		Yes	No

Other

Name	Years Completed	Did you Graduate		Course of Study
		Yes	No

References

Name *	Relationship *	Years Known *	Phone # *

Name	Relationship	Years Known	Phone #

Name	Relationship	Years Known	Phone #

Applicant Statement

I certify that all information I have provided in order to apply for and secure work with this employer is true, complete and correct.

I expressly authorize, without reservation, the employer, its representatives, employees or agents to contact and obtain information from all references (personal and professional), employers, public agencies, licensing authorities and educational institutions and to otherwise verify the accuracy of all information provided by me in this application, resume or job interview. I hereby waive any and all rights and claims I may have regarding the employer, its agents, employees or representatives, for seeking, gathering and using truthful and non-defamatory information, in a lawful manner, in the employment process and all other persons, corporations or organizations for furnishing such information about me.

I understand that this employer does not unlawfully discriminate in employment and no question on this application is used for the purpose of limiting or eliminating any applicant from consideration for employment on any basis prohibited by applicable local, state or federal law.

I understand that this application remains current for only 30 days. At the conclusion of that time, if I have not heard from the employer and still wish to be considered for employment, it will be necessary for me to reapply and fill out a new application.

If I am hired, I understand that I am free to resign at any time, with or without cause and with or without prior notice, and the employer reserves the same right to terminate my employment at any time, with or without cause and with or without prior notice, except as may be required by law. This application does not constitute an agreement or contract for employment for any specified period or definite duration. I understand that no supervisor or representative of the employer is authorized to make any assurances to the contrary and that no implied oral or written agreements contrary to the foregoing express language are valid unless they are in writing and signed by the employer's president.

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 an I-9 Form in this regard.

This Company does not tolerate unlawful discrimination in its employment practices. No question on this application is used for the purpose of limiting or excluding an applicant from consideration for employment on the basis of his or her sex, race, color, religion, national origin, citizenship, age, disability, or any other protected status under applicable federal, state or local law. This Company likewise does not tolerate harassment based on sex, race, color, religion, naional origin, citizenship, age, disability, or any other protected status. The Company takes all complaints of harassment seriously and all complaints will be investigated promptly and thoroughly.

I understand that any information provided by me that is found to be false, incomplete or misrepresented in any respect, will be sufficient cause to (i) eliminate me from further consideration for employment, or (ii) may result in my immediate discharge from the employer's service, whenever it is discovered.

Do Not Submit Until you have read the above applicant statement

I certify that I have read, fully understand and accept all terms of the foregoing Applicant Statement.*


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