Application for Employment

 PLEASE PRINT THIS APPLICATION COMPLETE ALL ENTRIES AND SEND IT TO

Butchko Bros. inc. is located along
U.S. Route 119 (Dunbar Intersection)
P.O. Box 675
Connellsville, PA  15425
 

Butchko Bros., Inc. is an Equal Opportunity Employer.  Employment offers are made on the basis of qualifications, and without regard to race, sex, religion, national or ethnic origin, disability, age, veteran status, or sexual orientation.

PLEASE TYPE OR PRINT.  Complete the entire application.  You may attach a resume, but you must still complete all questions; or your application will be deemed incomplete and may not be considered.  Please fill out each box (don't just indicate “See Resume.”)  Applications with missing or invalid job numbers will not be considered for any position. 

Position Applying For:	Name  (Last, First, Middle):						Other names under which you have attended school or been employed:
Street Address:				City, State & Zip:
Social Security Number:		Home Phone:			Cell Phone:		Other Phone:
Are you eligible to work in the United States?			Yes     No
Are you 18 years of age or older?			Yes     No			If NO,   what is your current age?
Are you currently on “lay-off” status or subject to recall?			Yes      No			If YES, Please explain.
Date available to start employment?						Expected Rate of Pay?  $________ per hour
Are you related to any current       (company employee)?			Yes     No			If YES, their name & their relationship to you?
If required for position, do you have a valid driver’s license?			Yes    No			If YES, State of issuance, license #, and expiration date:
How did you learn about this employment opportunity at      ?   Check all that apply:     Ad in newspaper  Job Bulletin (Posting) /Walk-in Website       Dept. of Labor                                    Ad in magazine  Referral by employee  Other:

 

        EDUCATION

Name of School	City/State	Did you graduate?	If No, # of years left to graduate	If Yes,  date of Graduation	Degree received	Major
High School:		Yes    No
GED:		Yes    No
Other School:		Yes    No
College:		Yes    No
College:		Yes    No
Other credentials/ licenses/ professional affiliations, etc., which are relevant to the job(s) for which you are applying.

      

SKILLS:  Please list technical skills, clerical skills, trade skills, etc., relevant to this position.  Include relevant computer systems and  software packages of which you have a working knowledge, and note your level of proficiency (basic, intermediate, expert)

 

WORK EXPERIENCE-Please detail your entire work history.  Begin with your current or most recent employer.  If you held multiple positions with the same organization, detail each position separately.  Attach additional sheets if necessary.  Omission of prior employment may be considered falsification of information. Please explain any gaps in employment.  Include full-time military or volunteer commitments.  PLEASE DO NOT complete this information with the notation “See Resume.”   

PLEASE NOTE:  Butchko Bros., Inc.  reserves the right to contact all current and former employers for reference     information.

                                       

Dates Employed (most recent position) From:       To	Full time        Part-time   If part-time, # hrs./wk:	Title:
Starting Salary:	Organization Name and Address:
Final Salary:
Supervisor’s Name, Title and Phone  #:	Other Reference Name, Title and Phone #:	Contact my current references:  At any time  Only if I am a finalist candidate
Primary duties:		Reason for Leaving:
Dates Employed (most recent position) From:       To	Full time        Part-time   If part-time, # hrs./wk:	Title:
Starting Salary:	Organization Name and Address:
Final Salary:
Supervisor’s Name, Title and Phone  #:	Other Reference Name, Title and Phone #:	Contact my current references:  At any time  Only if I am a finalist candidate
Primary duties:		Reason for Leaving:

 

References:
Name:
Phone:
Name:
Phone:
Name:
Phone:
Name:
Phone:

  PLEASE READ CAREFULLY AND SIGN THAT YOU UNDERSTAND AND ACCEPT THIS INFORMATION.

  I certify that the information on this application and its supporting documents is accurate and complete.  I understand and agree that failure to fully

 complete the form, or misrepresentation or omission of facts,  represents grounds for elimination from consideration for employment, or

termination after  employment if discovered at a later date.  I authorize Butchko Bros., Inc. to investigate, without liability, all statements contained

 in this  application and supporting materials.  I authorize references and former employers, without liability, to make full response to any inquiries

in connection  with this application for employment. If requested, I agree to submit to a physical exam, criminal and credit background

 investigation, and/or screening for illegal substances upon conditional offer of employment.  I understand that this document is NOT an offer of employment, and that an offer of  employment, if tendered, does NOT constitute a contract for continued guaranteed employment.  I understand

 that staff employees of Butchko Bros., Inc. serve at-will, and the employment relationship may be terminated at any time by either party,

or any or no reason, other than a reason prohibited by law.

 If employed, I will be required to furnish proof of eligibility to work in the United States.  I understand that if employed on a temporary basis,

 I would be paid for hours  worked only, and would be ineligible for benefits including paid time off.  If employed on a regular,

benefits-eligible basis,   I understand that  any benefits I receive may be  subject to change or discontinuation at any time without prior notice. 

I understand that the first SIX MONTHS  of regular employment represent a  provisional period, during which I may be  terminated

without right of appeal.

 

      

Applicant Signature: _______________________________________     
 Date: ________________