Step 1 of 7 0% PERSONAL INFORMATIONName* First Middle Last Social Security Number* Present Address* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Email Address* Enter Email Confirm Email Day Phone*Drivers License Number* Issuing State* AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State Drivers License Class* Class A Class B Class C EMPLOYMENT DESIREDPosition Applied For* Salary Desired*Type* Full Time Part Time Temporary Seasonal Date you can start* MM slash DD slash YYYY Are you employed now?* Yes No Have you ever applied for a position with Cold Technologies, LLC dba: Imperial Ice before?* Yes No Are you on lay-off and subject to recall?* Yes No Will you work overtime if required?* Yes No Are you able to meet the attendance requirements of this position?* Yes No Have you been convicted of a felony in the last seven (7) years?*A conviction does not constitute an automatic bar to employment unless relevant to the type of employment. Yes No EDUCATION Academic - Currently Attending Name & Location of School Did you Graduate? Yes No Subjects Studied EDUCATION Academic - Last CompletedName & Location of School Number of Years CompletedDid you Graduate? Yes No Subjects Studied EDUCATION Trade/Other - Currently AttendingName & Location of School Number of Years CompletedDid you Graduate? Yes No Subjects Studied EDUCATION Trade/Other - Last CompletedName & Location of School Number of Years CompletedDid you Graduate? Yes No Subjects Studied VOLUNTARY AFFIRMATIVE ACTION INFORMATION We comply with government regulation including Affirmative Action. In an effort to comply with requirements regarding government record keeping and other legal obligations, we ask that you complete this data survey. Your cooperation is appreciated. Please be advised that your survey is considered confidential information that will not be used in any employment matters.Sex* Male Female Race* Hispanic / Latino Black / African American White / American Indian / Alaskan Native Asian Pacific Islander / Native Hawaiian Two or more races SKILLS AND QUALIFICATIONSSkills*Summarize special skills and qualifications acquired from employment or other experiences that may qualify you to work with our company: FORMER EMPLOYERS List below, your last two employers, starting with the most recent one first. Employer #1Date Empoyed From* MM slash DD slash YYYY Date Empoyed To* MM slash DD slash YYYY Name of Previous Employer* First Last Address of Previous Employer* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Salary*Job Title* Reason for Leaving* FORMER EMPLOYERS Employer #2Date Empoyed From* MM slash DD slash YYYY Date Empoyed To* MM slash DD slash YYYY Name of Previous Employer* First Last Address of Previous Employer* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Salary*Job Title* Reason for Leaving* REFERENCES List below, three references.Name of Reference #1* First Last Phone Number*Name of Reference #2* First Last Phone Number*Name of Reference #3* First Last Phone Number* FOREIGN LANGUAGES List any foreign languages skills that you have and check which best describe your capabilities.Language Untitled Fluent Good Fair CONDITIONS OF EMPLOYMENTConditions of Employment*I give Cold Technologies, LLC dba: Imperial Ice the right to investigate all references and to secure additional information about me, if job related. I hereby release from liability Cold Technologies, LLC dba: Imperial Ice and its representatives for seeking such information and all other persons, corporations or organizations for furnishing such information. It is understood and agreed upon that any misrepresentation or omission by me in this application will be sufficient cause for cancellation of this application and/or separation from the Company's service if I have been employed. Furthermore, I understand that just as I am free to resign at anytime, the Company reserves the right to terminate my employment at anytime. with or without cause and without prior notice. Reporting to work with impaired abilities; or the possession, consumption or distribution of drugs or alcohol on Company or Client premises and/or worksites, will be grounds for disciplinary action, including discharge. A condition of employment includes a willingness on the part of the applicant or employee to agree to physical examination, and/or substance testing, if requested by Cold Technologies, LLC dba: Imperial Ice. We are committed to operating a drug free workplace. Violations of our drug and alcohol policy may result in dismissal. Cold Technologies, LLC dba: Imperial Ice is an Equal Opportunity Employer. The company does not discriminate in employment and no question on this application is used for the purpose of limiting or excusing any applicant's consideration for employment on a basis prohibited by the local, state, or federal law. This application is current for 60 days. At the conclusion of this time, if I have not heard from Cold Technologies, LLC dba: Imperial Ice and still wish be considered for employment, it will be necessary to fill out a new application. I have carefully read the above Conditions of Employment and I understand and agree to the termsSignature*Date* MM slash DD slash YYYY NameThis field is for validation purposes and should be left unchanged.
