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Step 1 of 7 14% Personal InformationFirst Name*Middle InitialLast Name*Address* Street Address City State Zip Code AfghanistanÅland IslandsAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzechiaDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRéunionRomaniaRussian FederationRwandaSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTürkiyeTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUS Minor Outlying IslandsUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabwe Country Email* Phone*Alt PhoneIf hired, can you provide evidence of legal eligibility to work in the U.S?*Any offer of employment is conditioned upon completing form I-9 and providing the appropriate documents for identity and work authorizationPosition DesiredWage/Salary DesiredJob Type Full Time Part TIme Have you ever been convicted of a felony, or a misdemeanor involving any violent act, use or possession of a weapon, or act of dishonesty for which the record has not been sealed or expunged, or do you have such a case pending?If yes, when?If yes, where?Date you can begin work?Are you 18 years of age or older?* If under 18 years of age, you will be required to submit a birth certificate or work certificate as required by California or federal law. Education InformationName of high school attendedCity & StateGraduate?GED? Name of college or technical schoolCity & StateGraduate?Degree?Major? Are you presently enrolled in school?List any job-related skills or accomplishments, including military serviceIf yes, give name & address of school and expected degree date Your Availability For Work FromToMondayFromToTuesdayFromToWednesdayFromToThursdayFromToFridayFromToSaturdayFromToSundayFromToTotal hours per week you are available to workDo you have any special requests or needs for a work schedule? Your References Give Three References That Are Not Former Employers Who We May ContactName and Occupation:How do you know them, and for how long?Phone Number:UntitledUntitledUntitledUntitledUntitledUntitledUntitledUntitledUntitled Your Employment HistoryEmployment History #1Name of Employer*DutiesJob Title*Dates of Employment:From* To* Address Street Address City State / Province / Region ZIP / Postal Code TelephoneHourly pay or salary:Starting pay:Ending pay:Reason for Leaving*Employment History #2Name of Employer*DutiesJob Title*Dates of Employment:From* To* Address Street Address City State / Province / Region ZIP / Postal Code TelephoneHourly pay or salary:Starting pay:Ending pay:Reason for Leaving*Employment History #3Name of Employer*DutiesJob Title*Dates of Employment:From* To* Address Street Address City State / Province / Region ZIP / Postal Code TelephoneHourly pay or salary:Starting pay:Ending pay:Reason for Leaving* Driving RecordState of issue:*Exp. Date* Have you had any vehicle accidents in the past 3 years in which you were at fault?* Yes No If so, describe the causes, damages & any injuries to yourself or others:Have you had any moving violations (speeding tickets, etc.) during the past 3 years?* Yes No If so, describe the dates, nature & locations of the moving violations: Additional InformationPlease use the space provided for any additional information that could help you qualify for the position you are applying for. Examples include; classes, certificates, current licenses, specific equipment and other skills.CAREFULLY READ EACH STATEMENT BEFORE APPLY*I certifY that all of the information provided in this employment application are true and complete to the best of my knowledge, and I authorize investigation of all statements contained in this application, including a criminal background and credit history check I understand that any false or incomplete information may disqualifY me from further consideration for employment and may result in my immediate discharge if discovered at a later date. I understand and acknowledge that unless otherwise defined by applicable law or written agreement with C.A. Newcomb & Sons, any employment relationship with C.A. Newcomb & Sons is considered "employment at will." This means the Employee may resign at any time and the Employer may discharge the Employee at any time, with or without cause, and with or without advance notice. I authorize the investigation of any or all statements contained in this application and also authorize any person, school, current employer, past employers, and other organizations to provide information concerning my previous employment and other relevant information that may be useful in making a hiring decision. I release such persons and organizations from any legal liability in making such statements. I have read, understand, and agree to the above statements.CAPTCHA
