Swanson & Youngdale, Inc. will not discriminate against or harass any employee or applicant for employment on the basis of race, creed, religion, sex, sexual or affectional preference, country of origin, ancestry, familial status, age, disability, marital status, status with regard to public or any other class protected by law. 

Please provide the following :
Items marked * are required fields.

Contact Information
Position Applied for:
Name of source  (If applicable):
*Referral Source:	---Select one--- Friend Employee Relative Surfing the Web Other
*Name:
*Street Address:
Address (cont.)
*City:
*State:	---Select a State--- Alabama Alaska Arizona Arkansas California Colorado Conneticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montanna Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming
*Zip/Postal Code:
*Home Phone:
Best time to call you at home is:
*E-mail:
*Social Security Number:
*Have you ever been employed here before?	No    Yes
If yes, give employment dates:
*Are you employed now?	No    Yes
May we contact your employer?	No    Yes
May we contact you at work?	No    Yes
If yes, work number and best time to call:
*Are you prevented from lawfully becoming employed in this country?	No    Yes
If hired, you will be required to submit documents sufficient to establish employment authorization and identity in compliance with the Immigration Reform and Control Act of 1986.  While you need not provide this proof of citizenship or Immigration status at the time you are interviewed, please be prepared to assure us that you can do so immediately upon being hired.
Are you available to work:	Full time Part time Temporary Seasonal
Days available  (Check all that apply):	Mon  Tues Weds Thurs Fri  Sat  Sun
*On what date are you available to start?
Expected salary:
*Will you work overtime if required?	No      Yes
*Are you willing to relocate if the job requires it?	No      Yes
*Are you willing to travel if the job requires it?	No      Yes
*Have you been convicted of a felony in the last seven (7) years?	No      Yes
If yes, explain.
Drivers License Number: (If required by job)
State:	---Select a State--- Alabama Alaska Arizona Arkansas California Colorado Conneticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montanna Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming
Education
Please list education or specialized experience which relates to the position(s) for which you are applying.  Exclude names or terms which indicate race, color, religion, gender, age, disability or national origin.
*Years Completed:  ---Select one--- 8th Grade 9th Grade 10th Grade 11th Grade 12th Grade High School Diploma Some Trade School Some College Completed Trade school Completed College
*Name & location of school:
Diploma/Degree:
Specialized Training, Apprenticeship, Skills, and Extra-Curricular Activities:
Honors received:
Special skills acquired from employment or other experience:
Employment Experience
Start with your present or last job.  Include military assignments and volunteer activities.  Exclude organization names which indicate race, color, religion, gender, age, disability, or national origin.
Employer 1
Start Date:
End Date:
Employer
Address:
Telephone Number
Job Title:
Starting wage:
Ending wage:
Supervisor:
Reason for leaving:
May we contact for reference?	No      Yes
Please summarize the nature of the work performed:
Employer 2
Start Date:
End Date:
Employer
Address:
Telephone Number
Job Title:
Starting wage:
Ending wage:
Supervisor:
Reason for leaving:
May we contact for reference?	No      Yes
Please summarize the nature of the work performed:
Employer 3
Start Date:
End Date:
Employer
Address:
Telephone Number
Job Title:
Starting wage:
Ending wage:
Supervisor:
Reason for leaving:
May we contact for reference?	No      Yes
Please summarize the nature of the work performed:
References
List the names and telephone numbers of three business or work references who are not related to you and are not previous supervisors.  If not applicable, list three school or personal references who are not related to you.
*Name:	*Telephone:	*Years known:
State any comments or additional information you feel may be helpful to us in considering your application:
APPLICANT'S  STATEMENT (Please read before submitting application)   I understand and agree that any misrepresentation by me in this application will be sufficient cause for the rejection of this application and/or termination of employment if I am hereafter employed by the Company.  Furthermore, if I am hired, I understand that I am free to resign at any time, and that the Company reserves the right to terminate my employment at any time, with or without cause.  and without prior notice.  I understand that no representative of the Company has authority to make representations or assurances to the contrary.  I acknowledge and agree that any changes in such employment relationship must be made in writing and signed by an authorized representative of the Company. I understand that if you make an offer of employment to me it may be a confidential offer of employment and I may be required to submit to a pre-employment medical exam and to provide information in response to your medical inquiries, the results of which might disqualify me from employment.  If requested, I agree to furnish such information and to submit to such examinations. I understand that I may be requested to submit to a test to detect the current illegal use of drugs and, if the test results identify that I am a current illegal user of drugs, I will not be eligible for employment by the Company.  I further understand that I have the right to refuse to submit to such tests or to consent to such tests of my own free will. I authorize the Company to make a thorough investigation of my past employment,  education, and job-related activities.  To the extent permitted by law, I release the Company from any liability which might result from making such investigations and I also release from liability all persons and entities supplying such information. I acknowledge that the Company is an equal opportunity employer and that the Company does not discriminate in employment.  I understand that no question on this application is used for the purpose of limiting or excluding the Company's consideration of me for employment on a basis prohibited by federal, state, or local law, nor is it used by the Company for the purpose of attempting to obtain information prohibited by federal, state, or local law. I understand that the Company will consider this application to contain current information for a period of only sixty (60) days.  At the expiration of sixty (60) days, if I have not heard from the Company and if I still desire to be considered for employment, I understand that it will be necessary for me to complete a new application.
By submitting this form, the applicant agrees to the above statement.