Employment Application

Drury Southwest, Inc (the "Company") is an Equal Opportunity Employer, dedicated to a policy of non-discrimination in hiring and every aspect of employment without regard to an individual's race, color, creed, religion, age, national origin, gender, sexual orientation, marital status, disability , or any other characteristic protected by applicable federal and/or state law.

Date

Name*

(Last, First, Middle)

Email*

Phone*

Address*

Street Address City State ZIP Code

Previous Address

Street Address City State / Province / Region ZIP / Postal Code

Position applying for:

When are you available to work?

Full Time

Part Time

Sun

Mon

Tue

Wed

Thu

Fri

Sat

What prompted you to apply with the company?

Walk-in

Newspaper Ad

Job Fair

Internet

Referred by friend/relative

Sent Resume

Other:

Other

Minimum Acceptable Pay:*

EMPLOYMENT HISTORY

List your work experience beginning with the most recent.

Employer's Name, Address, and Phone Number

Start Date:

End Date:

Your Position, Duties, Supervisor

Reason for Leaving

May we contact?

Yes

Employer's Name, Address, and Phone Number

Start Date:

End Date:

Your Position, Duties, Supervisor

Reason for Leaving

May we contact?

Yes

Employer's Name, Address, and Phone Number

Start Date:

End Date:

Your Position, Duties, Supervisor

Reason for Leaving

May we contact?

Yes

Name*

Person to notify in case of emergency

Relationship

Phone

Address

Street Address City State / Province / Region ZIP / Postal Code

Educational History

High School Name and Location

Type of Degree or Certificate Received

Check Highest Level Completed

College/Vocational Name and Location

Type of Degree or Certificate Received

Check Highest Level Completed

Post Graduate Name and Location

Type of Degree or Certificate Received

Check Highest Level Completed

Miscellaneous Data

Are you authorized to work in the U.S.A?*

Yes

Have you been previously employed by the Company?*

Yes

Do you have any relatives or friends employed by the Company?*

Yes

Are you physically capable or performing the essential functions of the job for which you are applying either with or without a reasonable accommodation?*

Yes

State any other information you feel may be helpful to the Company in considering your application.

Summarize any special work-related skills and qualifications acquired from other employment or experience.

I certify that the above information is correct and complete. I understand that I must meet the physical requirements and health standards established by the Company that are necessary to perform the essential functions of the positions for which I have applied as a condition of employment. I understand the a physical exam may be required to ensure I can perform the essential functions of the position for which I have applied, either with or without a reasonable accommodation. At any time during my employment, I may be subject to drug and alcohol testing in accordance with applicable law and regulations. Any positive test result at limits set by the Company in its sole discretion may result in my immediate discharge. Drury may obtain information from any law enforcement agency, any credit reporting agency or any other company, individual or agency concerning my personal background or history. I understand that if any information I have provided to the Company during the employment process, or at any time during my employment, conflicts with any information obtained by the Company, I may be subject to termination when discovered. I further understand that my employment can be terminated any time at the option of either the Company or myself. I agree to abide by all rules of the Company.

File

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Signature

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