Personal Information Education Employment History Other Qualifications References Terms of Employment Name BASIC INFORMATION First Name * Last Name * Street Address 1 * Street Address 2 City * State * - Select Province/State - Alberta British Columbia Manitoba New Brunswick Newfoundland and Labrador Nova Scotia Northwest Territories Nunavut Ontario Prince Edward Island Quebec Saskatchewan Yukon ==================== Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District Of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Phone Number * Email Address * Are You At Least 18 Years Old? * Yes No Are You Legally Eligible to Work in the USA? * Yes No EMPLOYMENT DESIRED Are You Seeking Full- or Part-Time Work? * Full-Time Work Part-Time Work When Could You Start? * Immediately Two Weeks or More What Shifts Can You Work? First-Shift (Day Shift) Second-Shift (Evenings) Third-Shift (Overnight) Weekends (Saturday/Sunday) Preferred Position * Pick-Pack Team Warehouse Team Receiving/Returns Team Maintenance Team Janitorial Team Customer Service Team Sales & Marketing Team Accounting Team Operations Management Human Resources Executive Team Other EDUCATION - HIGH SCHOOL High School Attended * City * State * - Select Province/State - Alberta British Columbia Manitoba New Brunswick Newfoundland and Labrador Nova Scotia Northwest Territories Nunavut Ontario Prince Edward Island Quebec Saskatchewan Yukon ==================== Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District Of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Did You Graduate? * Yes No EDUCATION - COLLEGE College Attended City State - Select Province/State - Alberta British Columbia Manitoba New Brunswick Newfoundland and Labrador Nova Scotia Northwest Territories Nunavut Ontario Prince Edward Island Quebec Saskatchewan Yukon ==================== Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District Of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Major and Degree Program Years Attended 0 Did You Graduate? Yes No EDUCATION - GRADUATE, PROFESSIONAL, OR TRADE SCHOOL College or Program Attended City State - Select Province/State - Alberta British Columbia Manitoba New Brunswick Newfoundland and Labrador Nova Scotia Northwest Territories Nunavut Ontario Prince Edward Island Quebec Saskatchewan Yukon ==================== Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District Of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Major, Degree Program, or Certification Years Attended 0 Did You Graduate? Yes No Notes or More Information (Optional) ADDITIONAL SKILLS OR CERTIFICATIONS Are You Certified in LEAN or SIX-SIGMA? Yes No Do You Have Fork Truck Certification or Experience? Yes No Do You Have First-Aid Certification? Yes No Are You Fluent in Microsoft Word and Excel? Yes No EMPLOYMENT HISTORY Most Recent or Current Employer * City * Position Title * State * - Select Province/State - Alberta British Columbia Manitoba New Brunswick Newfoundland and Labrador Nova Scotia Northwest Territories Nunavut Ontario Prince Edward Island Quebec Saskatchewan Yukon ==================== Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District Of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming When Did You Start This Position? * When Did You Leave This Position? * Name of Last Supervisor * Phone Number * List the Duties Performed, Skills Used or Learned, Advancements or Promotions, etc. * Reason for Leaving (Be Specific) * Previous Employer * City * Position Title * State * - Select Province/State - Alberta British Columbia Manitoba New Brunswick Newfoundland and Labrador Nova Scotia Northwest Territories Nunavut Ontario Prince Edward Island Quebec Saskatchewan Yukon ==================== Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District Of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming When Did You Start This Position? * When Did You Leave This Position? * Name of Last Supervisor * Phone Number * List the Duties Performed, Skills Used or Learned, Advancements or Promotions, etc. * Reason for Leaving (Be Specific) * Previous Employer City Position Title State - Select Province/State - Alberta British Columbia Manitoba New Brunswick Newfoundland and Labrador Nova Scotia Northwest Territories Nunavut Ontario Prince Edward Island Quebec Saskatchewan Yukon ==================== Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District Of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming When Did You Start This Position? When Did You Leave This Position? Name of Last Supervisor Phone Number List the Duties Performend, Skills Used or Learned, Advancements or Promotions, etc. Reason for Leaving (Be Specific) OTHER QUALIFICATIONS Did You Serve in the Military? * Yes No Please List Your Service Duties, Specialized Training, and Any Special Recognitions You Received Are You Currently Employed? * Yes No Do You Hold a Valid Driver's License? * Yes No Have You Ever Been Convicted of a Felony? * Yes No Have You Been Employed by EFS Before? * Yes No Do You Have Reliable Transportation To Work? * Yes No Do You Have Family or Friends Who Work at EFS? * Yes No If So, Please List Their Names: Please Provide a Detailed Example of a Time You Worked Collaboratively With a Team to Achieve a Goal. * Please Describe Your Relationship With Your Last Immediate Supervisor, and What Would They Say About You? * Please Provide a List of Your Personal Strengths. These Need Not Be Job-Related. * Please Provide a List of Your Personal Weaknesses. * Describe Yourself in One Word. * Have You Been Fired For Cause in the Past? * Yes No FIRST REFERENCE First Name * Last Name * Relationship to Reference * Please Select Someone Other Than a Relative Company or Organization * Former Employers are Preferred Phone Number * Email Address SECOND REFERENCE First Name * Last Name * Relationship to Reference * Please Select Someone Other Than a Relative Company or Organization * Former Employers are Preferred Phone Number * Email Address THIRD REFERENCE First Name * Last Name * Relationship to Reference * Please Select Someone Other Than a Relative Company or Organization * Former Employers are Preferred Phone Number * Email Address TERMS OF EMPLOYMENT - PLEASE READ CAREFULLY I affirm that all statements I have made on this employment application are true and complete. I understand that any false or misleading statements or material omissions may result in the denial of employment or, if I am employed, in the termination of my employment. I agree that my employment with eFulfillment Service will be at will and may be terminated by me or the company at any time, with or without cause and with or without notice. I agree that no one other than the president of the company in a written contract has any authority to limit the company’s right to terminate employment at will, or to offer employment other than on an at-will basis, and that any such agreement must be in writing and signed by the president. I agree that I will not disclose to anyone or use for my own purposes any of the company’s confidential or proprietary information, either during or after my employment, except at the request and for the benefit of the company. I agree that information about the company’s customers, vendors, sources of supply, pricing, costs, and other non-public financial information, products, services, methods of operation, marketing, engineering methods, production, and the like is confidential and proprietary information that belongs to the company. If my employment with the company ends, I will not retain any copies or summaries of any such information, and I will promptly return all such information to the company. I also agree that I will disclose and assign to the company any invention, design or process that I conceive or develop while employed by the company relating to the company’s business or to any product or service offered or being developed by the company, and that all such inventions, designs or processes belong to the company. I agree to submit to physical examinations permitted by law before and during my employment, at the request and expense of the company, and I agree to disclose all information lawfully requested at such examinations about my physical and mental condition and medical history. I also agree that before and during my employment, at the request and expense of the company, I will cooperate in such lawful medical tests (including blood, urine or other testing) as the company requests to check for drugs or alcohol in my system. I waive any claims against the company or its agents or any testing agency retained by the company or its agents relating to any such testing, or from lawful decisions made regarding my employment or termination of employment based upon the results of such testing or analysis. I agree that, except as prohibited by law the company may, during, or after my employment, disclose or discuss any lawfully permissible information or opinions relating to me or to my employment to employees of the company or to third parties. I waive written or other notice of any such disclosure, including disclosure of disciplinary matters, and I waive any claims against the company or its agents relating to any such disclosure or discussion. In consideration of EFulfillment Service Inc. review of my application, I agree that any claim or lawsuit arising out of my employment with, or my application for employment with, eFulfillment Service Inc. or any of its subsidiaries must be filed no more than six (6) months after the date of the employment action that is the subject of the claim or lawsuit. This includes claims or lawsuits against eFulfillment Service Inc. but also its owners, officers, employees and agents. I likewise agree that I will not join in any claim or lawsuit brought by any agency, other employee or third party that relates to any employment action occurring more than six (6) months prior to my joining. While I understand that the statute of limitations for claims arising out of an employment action may be longer than six (6) months, I agree to be bound by the six (6) month period of limitations set forth herein, and I HEREBY WAIVE ANY STATUTE OF LIMITATIONS TO THE CONTRARY. I agree to the above terms of employment. I agree that if any of the above terms is ever found to be legally unenforceable as written, such invalidity will not affect the validity of the rest of this agreement, and such term shall be limited to allow its enforcement as far as legally possible. I agree that no one other than the president of the company, by a written directive, has any authority to modify the above terms of employment, or to make any exception to them, or to offer employment on any other terms. I agree that I will be bound by and will adhere to any other rules and policies issued by the company, including all rules and policies contained in the company’s employee handbook. I understand that it is the policy of eFulfillment Service Inc. to verify employment eligibility, including social security numbers, for all employees. eFulfillment Service, Inc. is an equal employment opportunity employer. We adhere to a policy of making employment decisions without regard to race, color, religion, sex, sexual orientation, national origin, citizenship, age, or disability. We assure you that your opportunity for employment with eFulfillment Service, Inc. depends solely on your qualifications. I agree to the Terms of Employment * I Agree By checking this box you confirm that you have read and agree to the above Terms of Employment
