16 Aspen Drive, Randolph, NJ 07869 • Ph.: 973.927.9122 • Fax: 973.927.9123 • AspenIceArena.com

Today’s date ______

1.Position Applying for: ______

Type of shift you will accept: Day Evening Night Weekends

Type of job status you will accept:  Full TimePart Time

Desired Salary/Wage per Hr.: ______

If you obtain employment from Aspen Ice, Inc., and you are required to provide working papers, it is your responsibility to present them to Aspen Ice, Inc. prior to your first day of employment.

When are you available to start work: ______

2.Full Legal Name:______Date of Birth ______

(If under 18 years old)

3.Mailing Address:______

______

4.Social Security No.:______

5.Home PH. #______Cell:______

Email: ______

6.Education:

Indicate the highest level of education completed:______

7.Experience—Start with the most recent job describe all your working experience

•Job Title______May we contact your supervisor______

•Employer and Address______

______

•Type of business______

•Full or part time work______

•Reason for leaving______

•Job Title______May we contact your supervisor______

•Employer and Address______

______

•Type of business______

•Full or part time work______

•Reason for leaving______

•Job Title______May we contact your supervisor______

•Employer and Address______

______

•Type of business ______

•Full or part time work______

•Reason for leaving______

8.References—List name, address, telephone number, and relationship

  • ______
  • ______
  • ______
  • ______
  • ______
  • ______

9.Have you ever been convicted for any violation of law, including moving traffic violations?  YES  NO

Description of offense______Date of Conviction______

I understand that the employer follows an “employment at will” policy, in that I or the employer may terminate my employment at any time, or for any reason consistent with applicable state or federal law; this “employment at will” policy cannot be changed verbally or in writing, unless the change is specifically authorized in writing by the President of this organization. I understand that this application is not a contract of employment. I understand that federal law prohibits the employment of unauthorized aliens; all persons hired must submit satisfactory proof of employment authorization and identity; failure to submit such proof will result in denial of employment.

I understand this application will be active for a period of one year; after that time, if I wish to be considered for employment, I must submit a new application.

I understand that the employer will thoroughly investigate my work and personal history and verify all data given on this application, on related papers, and in interviews. I authorize all individuals, schools, firms named therein, except my current employer if so noted, to provide any information requested about me, and I release them from all liability for damage in providing this information.

I certify that all the statements herein are true and understand that any falsification or willful omission shall be sufficient cause for dismissal or refusal of employment.

Your Signature ______Today’s Date______

______

Do no write below this line office use only

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