*New* Eagle Beverage Employment Application

PERSONAL INFORMATION
Name*

First NameLast Name
Date*

MonthDayYear
Date
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*

Area CodePhone Number
Email*
example@example.com
Are you eligible to work in the U.S?*

YesNo
Are you at least 18 years or older? (If no, you may be required to provide authorizationto work.)*

YesNo
EMPLOYMENT DESIRED
Date you can start*

MonthDayYear
Date
Position desired*
Shift Preference*

DaysEveningsNights
Are you currently employed?*

YesNo
If so may we contact your present employer?*

YesNoN/A
Have you ever worked for this company before?*

YesNo
If yes please explain:
Are you able to perform the essential functions of the job for which you are applying, with or without a reasonable accommodation?*

YesNo
REFERRAL SOURCE
How did you hear about us?*

Walk InAdvertisementEmployee ReferralOther
If you were referred by a current employee of Eagle Beverage Company, who?
EDUCATION
High School (Name & Location)*
Degree/ Certificate/ License Received*
College or University (Name & Location)
Degree/ Certificate/ License Received
Trade, Business or Correspondence School (Name & Location)
Degree/ Certificate/ License Received
EMPLOYMENT HISTORY

Include your last seven (7) years of employment history, including periods of unemployment, starting with the most recent and working backwards in time.
Start*

MonthDayYear
Date
End

MonthDayYear
Date
Still Employed

YesNo
Employer Name:*
Job Title:*
Phone Number*

Area CodePhone Number
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Summarize the nature of work performed and job responsibilities:*
Reason for leaving:*
Start

MonthDayYear
Date
End

MonthDayYear
Date
Employer Name:
Job Title:
Phone Number

Area CodePhone Number
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Summarize the nature of work performed and job responsibilities:*
Reason for leaving:
Start

MonthDayYear
Date
End

MonthDayYear
Date
Employer Name:
Job Title:
Phone Number

Area CodePhone Number
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Summarize the nature of work performed and job responsibilities:
Reason for leaving:
Do you have any special skills, experience and/or training that would enhance your ability to perform the position applied for?*

YesNo
If yes, please explain:
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Please read carefully before signing.

I understand that neither the completion of this application nor any other part of myconsideration for employment establishes any obligation for Eagle Beverage Company to hireme. If I am hired, I understand that either Eagle Beverage Company or I can terminate myemployment at any time and for any reason, with or without cause and without prior notice. Iunderstand that no representative of Eagle Beverage Company has the authority to make anyassurance to the contrary.I attest with my signature below that I have given to Eagle Beverage Company true andcomplete information on this application. No requested information has been concealed. Iauthorize Eagle Beverage Company to contact references provided for employment referencechecks. If any information I have provided is untrue, or if I have concealed material information,I understand that this will constitute cause for the denial of employment or immediate dismissal.
Signature*

Clear
Date*

MonthDayYear
Date
Affirmative Action: Applicant Invitation to Self-Identify: Veteran, Gender and Race(VEVRAA & EO 11246)

Eagle Beverage Company is an equal opportunity employer. As required by law, we must record certain information to be made a part of our affirmative action program. Applicants for employment are invited to participate in the affirmative action program by reporting their status as a protected veteran or other minority. In extending this invitation, we advise you that: (a)workers (applicants) are under no obligation to respond but may do so in the future if they choose; (b)responses will remain confidential within the human resource department; and (c) responses will be used only for the necessary information to include in our affirmative action program. We are a company that values diversity. We actively encourage women, minorities, veterans and disabled employees to apply. Refusal to provide this information will have no bearing on your application and will not subject you to any adverse treatment.
Name*

First NameLast Name
Position Applied for:*
Gender*

MaleFemaleN/A
Race or Ethnicity* (select one)*

Hispanic or LatinoWhite (not Hispanic or Latino)Black or African American (not Hispanic or Latino)Native Hawaiian or Pacific Islander (not Hispanic or Latino)Asian (not Hispanic or Latino)American Indian or Alaskan Native (not Hispanic or Latino)Two or more races (not Hispanic or Latino)
Veteran Status***

I am a protected veteranI am NOT a protected veteranI do not wish to self-identify
How did you hear of our opening?*

Employee referralCompany websiteJob boardSocial media
Other – please explain:
*EEOC RACE/ETHNIC IDENTIFICATION CATEGORIES Hispanic or Latino - A person of Cuban, Mexican, Puerto Rican, South or Central American, or other Spanish culture or origin regardless of race. White (not Hispanic or Latino) - A person having origins in any of the original peoples of Europe, the Middle East or North Africa. Black or African American (not Hispanic or Latino) - A person having origins in any of the black racial groups of Africa. Native Hawaiian or Other Pacific Islander (not Hispanic or Latino) - A person having origins in any of the peoples of Hawaii, Guam, Samoa or other Pacific Islands. Asian (not Hispanic or Latino) - A person having origins in any of the original peoples of the Far East, Southeast Asia or the Indian Subcontinent, including, for example, Cambodia, China, India, Japan, Korea, Malaysia, Pakistan, the Philippine Islands, Thailand and Vietnam. American Indian or Alaska Native (not Hispanic or Latino) - A person having origins in any of the original peoples of North and South America (including Central America) and who maintain tribal affiliation or community attachment. Two or more races (not Hispanic or Latino) - All persons who identify with more than one of the above races.
**PROTECTED VETERAN DEFINITION Protected veteran means a veteran who may be classified as an active duty wartime or campaign badge veteran, disabled veteran, Armed Forces service medal veteran or recently separated veteran. Active duty wartime or campaign badge veteran means a veteran who served on active duty in the U.S. military, ground, naval or air service during a war or in a campaign or expedition for which a campaign badge has been authorized under the laws administered by the Department of Defense. Armed Forces service medal veteran means any veteran who, while serving on active duty in the U.S. military, ground, naval or air service, participated in a United States military operation for which an Armed Forces service medal was awarded pursuant to Executive Order 12985 (61FR 1209, 3 CFR, 1996 Comp., p. 159).Disabled veteran means (1) a veteran of the U.S. military, ground, naval or air service who is entitled to compensation (or who but for the receipt of military retired pay would be entitled to compensation) under laws administered by the Secretary of Veterans Affairs, or (2) a person who was discharged or released from active duty because of a service-connected disability. Recently separated veteran means a veteran during the three-year period beginning on the date of such veteran’s discharge or release from active duty in the U.S. military, ground, naval or air service.
Voluntary Self-Identification of Disability
Name*

First NameLast Name
Date*

MonthDayYear
Date
Why are you being asked to complete this form?

We are a federal contractor or subcontractor required by law to provide equal employment opportunity to qualified people with disabilities. We are also required to measure our progress toward having at least 7% of our workforce be individuals with disabilities. To do this, we must ask applicants and employees if they have a disability or have ever had a disability. Because a person may become disabled at any time, we ask all of our employees to update their information at least every five years. Identifying yourself as an individual with a disability is voluntary, and we hope that you will choose to do so. Your answer will be maintained confidentially and not be seen by selecting officials or anyone else involved in making personnel decisions. Completing the form will not negatively impact you in any way, regardless of whether you have self-identified in the past. For more information about this form or the equal employment obligations of federal contractors under Section503 of the Rehabilitation Act, visit the U.S. Department of Labor’s Office of Federal Contract Compliance Programs(OFCCP) website at www.dol.gov/ofccp.
How do you know if you have a disability?

You are considered to have a disability if you have a physical or mental impairment or medical condition that substantially limits a major life activity, or if you have a history or record of such an impairment or medical condition. Disabilities include, but are not limited to:
· Autism

· Autoimmune disorder, for example, lupus, fibromyalgia, rheumatoid arthritis, or HIV/AIDS

· Blind or low vision

· Cancer

· Cardiovascular or heart disease

· Celiac disease

· Cerebral palsy

· Deaf or hard of hearing

· Depression or anxiety

· Diabetes

· Epilepsy

· Gastrointestinal disorders, for example, Crohn's Disease, or irritable bowel syndrome

· Intellectual disability

· Missing limbs or partially missing limbs

· Nervous system condition for example, migraine headaches, Parkinson’s disease, or Multiple sclerosis (MS)

· Psychiatric condition, for example, bipolar disorder, schizophrenia, PTSD, or major depression
Please check one of the boxes below:

Yes, I Have A Disability, Or Have A History/Record Of Having A DisabilityNo, I Don’t Have A Disability, Or A History/Record Of Having A DisabilityI Don’t Wish To Answer
PUBLIC BURDEN STATEMENT: According to the Paperwork Reduction Act of 1995 no persons are required to respond to a collection of information unless such collection displays a valid OMB control number. This survey should take about 5 minutes to complete.
Should be Empty:

PERSONAL INFORMATION

EMPLOYMENT DESIRED

REFERRAL SOURCE

EDUCATION

EMPLOYMENT HISTORY

Please read carefully before signing.

Affirmative Action: Applicant Invitation to Self-Identify: Veteran, Gender and Race(VEVRAA & EO 11246)

Voluntary Self-Identification of Disability

Why are you being asked to complete this form?

How do you know if you have a disability?