Pre-Employment Online Application

Pre-Employment Online Application

Name (First, Middle, Last): *
Date of birth: *
Address: *
The BEST phone number to reach you at: *
Email Address (If used frequently):
Position applied for: *
Referred by:
Type of Employment (Full Time or Part Time): *
Are you willing to work overtime? *	Yes No
Are you willing to travel within the Chicagoland area? *	Yes No
Are you willing to travel within the Rockford area? *	Yes No
Do you have a PERC Card? *	Yes No
If Yes, PERC Number:
Have you ever been employeed for Menards, Homedepot, or Lowes? *	Yes No
Have you ever been convicted of a Misdemeanor or Felony? *	Yes No
If Yes, describe in full (A conviction does not necessarily disqualify an applicant from employment):
Date available to begin work: *
Work availability (List the days and hours you are available to work) : *
What divisions would you like to be considered to work in: Division 1 - Morton Grove, Chicago around Diversy & Clybourn, Chicago around Diversey & Cicero *	Yes No
Division 2 - Chicago around Diversy & Clybourn, Chicago around Diversey & Cicero, Melrose Park *	Yes No
Division 3 - Melrose Park, Hillside, Cicero *	Yes No
Division 4 - Hodgkins, Bridgeview, Crestwood, Tinley Park *	Yes No
Division 5 - Griffith, Dolton, Homewood *	Yes No
Division 6 - Joliet, Glendale Heights *	Yes No
Division 7 - Joliet, Morris *	Yes No
Division 8 - Rockford, Machesney Park *	Yes No
In addition to the above divisions, If there is a city that you would also like to be considered for, please list those cities:
I certify that all information supplied in this application is true and correct to the best of my knowledge. Any false or misleading information regarding this application will result in the rejection of this application or termination if employed by the Company. SIGNATURE: *
Date: *