Personal Information

Name

First Name

Last Name

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone

(###)

###

####

Email Address

Are you legally eligible for employment in the US?

Yes

Have you ever been convicted of a felony?

Yes

Are you at least 18 years old?

Yes

If no how old are you?

Position Information

What is your availability to work?

What days and hours during those days are you available to work?

How many hours a week would you like to work?

When can you start?

YYYY

Employment History

Most recent job description

Please list where you worked, when you worked there, what your duties were, who we can contact there, and your reason for leaving.

Previous jobs description

Please list the same as above for any additional jobs you've worked.

Education

Education received

Please list, with most recent first, all schools you have attended and what degree you received from them.

List Skills

Please list any special knowledge, skills, abilities, or experiences that may be helpful in considering your application

Certification & Authorization

I hereby certify that all statements made in this application are true and correct to the best of my knowledge and belief. I understand that any misrepresentations or omissions of facts in this application are grounds for disqualification from further consideration or for dismissal from employment. I authorize the company to inquire into my educational, professional, and past employment history references as needed to research my qualifications for this position. If employed, I agree to conform to the rules, regulations and policies of the company. I understand that I will be an employee “at will” and either the company or I may terminate my employment relationship at any time for any reason not in violation of law. I hereby acknowledge that I have read and fully understand the forgoing and seek employment under these conditions.

Please type your name to certify the above statement.

We have received your application.

If we find you are qualified, we will contact you for an

interview. Thank you for your interest with Purple Penguin.

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