Gloucester Brewing Company
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Applicant Name
*
First
Last
Email
*
Phone Number
Current Address
City
State
ZIP
How were you referred to GBC?
Position(s) applying for:
* Are you applying for:
Temporary Work – such as summer or holiday work?
Yes
No
Regular Part-Time work?
Yes
No
Regular Full-Time work?
Yes
No
What days and hours are you available for work?
If applying for temporary work, when will you be available?
If hired, on what date can you start working?
Can you work on the weekends?
Yes
No
Can you work evenings?
Yes
No
Are you available to work overtime?
Yes
No
Salary Desired:
* Personal Information:
Have you ever applied to / worked for GBC before? If yes, please explain (include date):
Do you have any friends, relatives, or acquaintances working for GBC? If yes, state name & relationship:
If hired, would you have transportation to/from work?
Yes
No
Are you over the age of 18?
Yes
No
(If under 18, hire is subject to verification of minimum legal age)
If hired, would you be able to present evidence of your U.S. citizenship or proof of your legal right to work in the United States?
Yes
No
If hired, are you willing to submit to and pass a controlled substance test?
Yes
No
Are you able to perform the essential functions of the job for which you are applying, either with / without reasonable accommodation?
Yes
No
If no, describe the functions that cannot be performed:
(Note: Gloucester Brewing Company complies with the ADA and consider reasonable accommodation measures that may be necessary for eligible applicants/employees to perform essential functions. It is possible that a hire may be tested on skill/agility and may be subject to a medical examination conducted by a medical professional.)
Have you ever been convicted of a criminal offense (felony or misdemeanor)?
Yes
No
If yes, please describe the crime – state nature of the crime(s), when and where convicted and disposition of the case:
(Note: No applicant will be denied employment solely on the grounds of conviction of a criminal offense. The date of the offense, the nature of the offense, including any significant details that affect the description of the event, and the surrounding circumstances and the relevance of the offense to the position(s) applied for may, however, be considered.)
EDUCATION, TRAINING AND EXPERIENCE
* High School
School Name:
Address:
City, State, Zip:
Number of Years Completed:
Did You Graduate?
Yes
No
Degree / Diploma Earned:
* College / University
School Name:
Address:
City, State, Zip:
Number of Years Completed:
Did You Graduate?
Yes
No
Degree / Diploma Earned:
* Vocational School
School Name:
Address:
City, State, Zip:
Number of Years Completed:
Did You Graduate?
Yes
No
Degree / Diploma Earned:
* Military
Branch:
Rank in Military:
Total Years of Service:
Skills / Duties:
Related Details:
Do you speak, write or understand any foreign languages?
Yes
No
If yes, describe which languages(s) and how fluent of a speaker you consider yourself to be.
Explain any other experience, training, qualifications, or skills which you feel should be brought to our attention, in the case that they make you especially suited for working with us:
* Employment History
Below, please describe past and present employment positions, dating back five years. Please account for all periods of unemployment. Even if you have attached a resume, this section must be completed.
Are you currently employed?
Yes
No
If you are currently employed, may we contact your current employer?
Yes
No
* #1
Name of Employer:
Name of Supervisor:
Telephone Number:
Business Type:
Address:
City, State, Zip:
Length of Employment (Include Dates):
Position & Duties:
Reason for Leaving:
May we contact this employer for references?
Yes
No
* #2
Name of Employer:
Name of Supervisor:
Telephone Number:
Business Type:
Address:
City, State, Zip:
Length of Employment (Include Dates):
Position & Duties:
Reason for Leaving:
May we contact this employer for references?
Yes
No
* #3
Name of Employer:
Name of Supervisor:
Telephone Number:
Business Type:
Address:
City, State, Zip:
Length of Employment (Include Dates):
Position & Duties:
Reason for Leaving:
May we contact this employer for references?
Yes
No
* References
List below three persons who have knowledge of your work performance within the last four years. Please include professional references only.
* 1
Full Name:
Telephone Number:
Address:
City, State, Zip:
Occupation:
Number of Years Acquainted:
* 2
Full Name
Telephone Number:
Address:
City, State, Zip:
Occupation:
Number of Years Acquainted:
* 3
Full Name
Telephone Number:
Address:
City, State, Zip:
Occupation:
Number of Years Acquainted:
* Please Read and Confirm Each Paragraph, then Sign Below
Please confirm
*
I certify that I have not purposely withheld any information that might adversely affect my chances for hiring. I attest to the fact that the answers given by me are true & correct to the best of my knowledge and ability. I understand that any omission (including any misstatement) of material fact on this application or on any document used to secure can be grounds for rejection of application or, if I am employed by this company, terms for my immediate expulsion from the company.
Please confirm
*
I understand that if I am employed, my employment is not definite and can be terminated at any time either with or without prior notice, and by either me or the company.
Please confirm
*
I understand and agree that the company may use the information I have provided to evaluate my candidacy for employment, which may include sharing it with third parties. The company may, at its discretion, perform a background check to verify any statements made by the applicant and permit the company to examine my references, record of employment, education record, any other information I have provided. I authorize the references I have listed to disclose any information related to my work record and my professional experiences with them, without giving me prior notice of such disclosure. In addition, I release the company, my former employers & all other persons, corporations, partnerships & associations from any & all claims, demands or liabilities arising out of or in any way related to such examination or revelation.
Applicant’s Signature:
Date:
Submit
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