It is our policy to comply with all applicable state and federal laws prohibiting discrimination in employmnet based on race, age, color, sex, religion, national origin, disability or other protected classification.

 ABOUT YOU
Name : 
Street Address : 
City, State : 
Telephone : 
email : 
Are you over 18? 
      YES 
      NO 
How did you learn of this opening? 
What intrigues you about a position with Backwoods? 
Have you been told the main functions of the job or have you been shown a copy of the job description listing the main functions of the job?
      YES 
      NO 
Can you perform these job functions with or without reasonable accommodation?
      YES 
      NO 
Are there any hours, shifts, or days you can not work or will not work? 
Shift preferred (Part-time / Full-time)
      PART-TIME 
      FULL-TIME 
Are you willing to work overtime as required?
                    YES 
                    NO 
Have you ever been convicted on a felony?
                    YES 
                    NO 
(Conviction will not necessarily disqualify an applicant for employment) If yes, describe the conditions: 
 
 
 YOUR EDUCATION & SKILLS
EDUCATION   
Name & Location of School
Year Graduated
Major 
Dipolma / Degree  
High School:  
College / University:  
Vocational / Trade :  
Other Training /  
Education :  
In addition to your work history (below), what other experiences, skills or qualifications would particularly fit you for work with our company? 
Positions applied for: 
Wage or Salary desired: 
When can you start? 
 
 
 WORK HISTORY
May we contact your present employer?
      YES 
      NO 
 YOUR MOST RECENT EMPLOYERS
Employer #1: 
 
Dates Employed:
Address: 
City: 
 
Phone:
Beginning Salary: 
 
Ending Salary:
Starting Position: 
Ending Position:
Description of Duties:
Name and Title of Supervisor:
Why did you leave?
Employer #2: 
 
Dates Employed:
Address: 
City: 
 
Phone:
Beginning Salary: 
 
Ending Salary:
Starting Position: 
Ending Position:
Description of Duties:
Name and Title of Supervisor:
Why did you leave?
Employer #3: 
 
Dates Employed:
Address: 
City: 
 
Phone:
Beginning Salary: 
 
Ending Salary:
Starting Position: 
Ending Position:
Description of Duties:
Name and Title of Supervisor:
Why did you leave?
Employer #4: 
 
Dates Employed:
Address: 
City: 
 
Phone:
Beginning Salary: 
 
Ending Salary:
Starting Position: 
Ending Position:
Description of Duties:
Name and Title of Supervisor:
Why did you leave?
 
 
 YOUR CERTIFICATION & AGREEMENT
I certify that the facts set forth in this Application for employment are true and complete to the best of my knowledge. I understand that if I am employed, false statements, omissions or misrepresentations may result in my dismissal. I authorize the Company to make an investigation of any of the facts set forth in this application and release the Company from any liability.

I understand that employment at this Company is "at-will," which means that either I or the Company can terminate the employment relationship at any time, with or without prior notice, and for any reason not prohibited by statute. All employment is continued on that basis. I understand that no supervisor, manager, or executive of the Company, other than the Chief Executive Officer has any authority to alter the foregoing.
I AGREE