Job-Submissions Job Application Application Information Position Applied For Date of Application * Applicant Information Name * First Last * Last Home Phone * Cell Phone * Address * Address Line 2 City * State * AL AK AR AZ CA CO CT DE DC FL GA HI ID IL IN IA KS KY LA ME MH MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY Zip Code * Email Drivers Licence Number * Employment Information When would you be available to begin work? * What is your hourly gross pay expectation? * Are you legally eligible to be employed in the United States? * Yes No Are you over 21 years of age? * Yes No Have you ever been convicted of a felony or a misdemeanor? * Yes No If yes (above), please explain. (A conviction will not necessarily result in the denial of employment.) Are you presently employed? * Yes No Employment Desired * Full-time Part-time Full- or Part- time Do you currently possess a Class A CDL? * Yes No Do you have a clean driving record? * Yes No (less than 4 points with NO alcohol related offenses) Education High School Name Location Course of Study Years Completed Degree / Diploma College Name Location Course of Study Years Attended Degree / Diploma Describe any specialized or technical training, apprenticeships, licenses, and/or skills Please list any academic honors, scholarships, offices held, etc. Personal References Name * Reference 1 Address Relationship Years Known * Phone Number * Name * Reference 2 Address Relationship Years Known * Phone Number * Name * Reference 3 Address Relationship Years Known * Phone Number * Employment Experience Employer 1 May we contact Employer 1 * Yes No Employer Name * Address * Phone Number * Job Title and duties performed * Supervisor’s Name * Dates employed * From Dates employed * To Hourly Rate/Salary * Starting Rate Hourly Rate/Salary * Final Rate Employer 2 May we contact Employer 2 Yes No Employer’s Name Address Phone Number Job Title and duties performed Supervisor’s Name Dates employed From Dates employed To Hourly Rate/Salary Starting Rate Hourly Rate/Salary Final Rate Employer 3 May we contact Employer 3 Yes No Employer’s Name Address Phone Number Job Title and duties performed Supervisor’s Name Dates employed From Dates employed To Hourly Rate/Salary Starting Rate Hourly Rate/Salary Final Rate Applicant’s Statement Please read carefully before answering below. I hereby certify that the above information provided by me in this application (or any other accompanying or required documents) is correct, accurate and complete to the best of my knowledge. I understand that the falsification, misrepresentation of omission of any facts in said documents will be cause for denial of employment or immediate termination of employment regardless of the timing or circumstances of discovery. I understand that submission of an application does not guarantee employment AND should an offer of “AT WILL” employment be extended by North Kansas City Beverage Co. (hereinafter, referred to as NKC Beverage) that such employment may be terminated by either NKC Beverage or myself at any time, with or without cause or notice. I understand that none of the documents, policies, procedures, actions, statements of NKC Beverage or its representatives used during the employment process is deemed a contract of employment, real or implied. I understand that if offered a position with NKC Beverage, I am required to submit to a pre-employment drug screening / physical, pre-employment driving record review, and a background check may be performed at any time during my employment as conditions of my employment. I understand that unsatisfactory results from, refusal to cooperate with, or any attempt to affect the results of these pre-employment tests and background check will result in withdrawal of any employment offer or termination of employment if already employed. I hereby authorize any and all schools, former employers, references, courts and any others who have information about me to provide such information to NKC Beverage and I release all parties involved from any and all liability for any and all damage that may result from providing such information. By checking below I acknowledge that I have read, understand and agree with the above statements and conditions. * Yes No reCAPTCHA If you are human, leave this field blank.