Bradford Company Application for Employment

1. Specific Position(s) Applied For*

2. How Did You Learn About Us?*

   AdvertisementFriendWalk-InEmployment AgencyRelativeOther
   

1. First Name*
   
2. Middle Initial
   
3. Last Name*
   
4. Address 1*
   
5. Address 2
   
6. City*
   
7. State
   ---AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming
8. Zip code*
   
9. Email*
   
10. Phone*
    

1. Are you authorized to work in the United States?*

   YesNo

2. Are you 18 years or older?*

   YesNo

3. Are you physically and mentally able to perform the essential functions of the position for which you are applying?*

   YesNo

   If no, and you wish to consider an accommodation to allow you to perform, please state the purpose and nature of the suggested accommodation:
   

4. Have you ever filed an application with us before?*

   YesNo

   If yes, give date:
   

5. Have you ever been employed with us before?*

   YesNo

   If yes, give dates:

   to

6. On what date would you be available to work?
   

7. Are you available to work:*

   Full TimePart Time

8. Preferred shift:*

   Day ShiftSecond ShiftNight Shift

9. Are you currently on "lay-off" and subject to recall?*

   YesNo

10. Have you been convicted of a felony within the last 7 years?*

    YesNo

    (Conviction will not necessarily disqualify an applicant from employment.)

    If yes, please explain:
    

8. Indicate any foreign languages you can speak, read and/or write
   
9. List professional, trade, business or civic activities or offices held.

   (You may exclude memberships which would reveal sex, race, religion, national origin, age, ancestry, disability or other protected status.)

1. Give name, address and telephone number of three references who are not related to you and are not previous employers.*

   1. Name*
      
      Address*
      
      Telephone Number*
      
   2. Name*
      
      Address*
      
      Telephone Number*
      
   3. Name*
      
      Address*
      
      Telephone Number*
      

2. Have you gone by any other names in the last five (5) years?*

   YesNo

   If yes, list the names:
   

3. Have you ever had any job-related training in the United States military?*

   YesNo

   If yes, please describe:
   

Start with your present job. Include any job-related military service assignments and volunteer activities. You may exclude memberships which would reveal sex, race, religion, national origin, age, ancestry, disability or other protected status.

1. Summarize special job-related skills and qualifications acquired from employment or other experience.
   

1. Please attach your resume, if any.
   

I affirm that the information provided on this application (and accompanying resume, if any) is true and complete to the best of my knowledge. I also agree that any false information, misrepresentations, or omissions of fact on this application or during the prehire process may disqualify me from further consideration for employment and may result in discipline or dismissal if discovered at a later date.

I authorize a thorough investigation of my past employment and/or educational background, including discipline records, and agree to cooperate in such investigations. I authorize the company to conduct any background investigation on me it deems appropriate including, but not limited to, credit and criminal checks. I release from all liability and responsibility all persons and other entities for supplying such information and waive any right to notice of such disclosure.

If offered employment, I agree to any psychological or physical testing which may be necessary to determine my ability to perform the essential functions of the job for which I am being considered. I further authorize any physician or entity conducting such medical examination to release the results of such examination to Bradford Company.

I also understand that if I have a protected disability that affects my ability to do the job I seek, I may ask Bradford Company to make a reasonable accommodation for it. I must make my request in writing to the personnel department with 182 days after the date I know that an accommodation is needed.

I give my consent for Bradford Company, through an authorized testing service of its choice, to collect specimens of my blood, urine or other fluids, hair or other tissues for chemical analysis and to conduct any other necessary medical tests to determine the presence of alcohol, drugs or controlled substances, and I hereby release Bradford Company from any liability arising out of such tests or its results. Further, I give my consent for the release of the test results and other relevant medical information to authorized management for appropriate review. If I am accepted for employment, I hereby consent to be tested in the above manner during my employment when required by federal, state or local law, or at the Company's sole discretion, and I acknowledge that remaining free of illegal drug use is a condition of my employment.

I understand that all employees of Bradford Company are employed on an indefinite basis and are subject to termination at any time with or without notice, with or without prior discipline or warning and with our without cause. No person other than the Senior Vice President or President of Bradford Company has authority to offer employment for any specified period or to make any contract contrary to the foregoing. No such agreement will be enforceable unless it is in writing, pertains specifically to me, and is signed by the Senior Vice President or President.

1. Applicant's Signature*
   

   (Type your name. This constitutes your electronic signature.)

2. Date*