Position(s) Applying For
Date Applying
First Name
Last Name
Are you 18 years or older?
Yes
No
Address
Address 2
City
State
Zip
Phone - Please use the format (XXX-XX-XXXX)
Alternative Phone - Please use the format (XXX-XX-XXXX)
Email
Are you related to any Stone Belt employee or board member?
Yes
No
If so, list names:
Have you been employed at Stone Belt before?
Yes
No
If yes, when?
Have you worked under any other names?
Yes
No
If so, list names:
How did you learn about Stone Belt? Check all that apply.
Newspaper   Internet   Unemployment Office   Job Fair Reputation   Indeed.com   Other
Please list the names of items checked above or list details:
Verification of your legal right to work in the United States will be required after employment. Will you be able to supply such verification?
Yes
No
Some examples include: driver's license, social security card, birth certificate, US military card, INS employment authorization.
Are you on layoff or subject to recall with another employer?
Yes
No
If hired, will you be able to perform the essential functions of the job you have applied for?
Yes
No
During the last ten years, have you ever been convicted of a crime that has not been expunged by a court?
Yes
No
If yes, please explain in detail, including the date of the incident:
(A conviction will not automatically disqualify you for employment. Factors such as date of conviction, seriousness and nature of the crime, and rehabilitation will be considered.)
Do you have a valid driver's license?
Yes
No
Have you received any moving violations (speeding or traffic tickets) or a DUI/DWI/OWI in the last five years?
Yes
No
If yes, please explain:
Employment History: List employment started with your most recent position. Please give an accurate and complete record of all full-/part-time employment in the space provided and account for all periods of unemployment. DO NOT write "see resume" or "see previous application." This section must be filled out completely, or this application will not be processed.
Employer 1
Full Address
Phone
Email
Supervisor
Dates (MM/YYYY - MM/YYYY)
Number of hours per week
Starting Salary
Ending Salary
Job Duties
Reason for Leaving
Voluntary/Involuntary
Yes
No
Employer 2
Full Address
Phone
Email
Supervisor
Dates (MM/YYYY - MM/YYYY)
Number of hours per week
Starting Salary
Ending Salary
Job Duties
Reason for Leaving
Voluntary/Involuntary
Yes
No
Employer 3
Full Address
Phone
Email
Supervisor
Dates (MM/YYYY - MM/YYYY)
Number of hours per week
Starting Salary
Ending Salary
Job Duties
Reason for Leaving
Voluntary/Involuntary
Yes
No
Volunteer Experience: List volunteer positions starting with your most recent position. Please give an accurate and complete record of all volunteer experience obtained in the space provided and account for all periods of unemployment. DO NOT write "see resume" or "see previous application." This section must be filled out completely, or this application will not be processed.
Organization 1 / City
Phone
Contact Person
Dates (MM/YYYY - MM/YYYY)
Details
Organization 2 / City
Phone
Contact Person
Dates (MM/YYYY - MM/YYYY)
Details
Organization 3 / City
Phone
Contact Person
Dates (MM/YYYY - MM/YYYY)
Details
High School: Need the School Name/Location, Course of Study, Level Completed, If you Graduated or not, and the Degree Name
College: Need the School Name/Location, Course of Study, Level Completed, If you Graduated or not, and the Degree Name
Graduate/Professional: Need the School Name/Location, Course of Study, Level Completed, If you Graduated or not, and the Degree Name
Business/Vocational: Need the School Name/Location, Course of Study, Level Completed, If you Graduated or not, and the Degree Name
Personal References: DO NOT include supervisors already listed above or any relatives.
Reference 1 Name
Relationship
Number of Years Acquainted
Phone
Email
Reference 2 Name
Relationship
Number of Years Acquainted
Phone
Email
Reference 3 Name
Relationship
Number of Years Acquainted
Phone
Email
List any job-related special skills acquired, seminars attended, job training received, machines you can operate, computer programs, etc.
Honors received, professional memberships, offices:
If you would like to include a resume, click the "Choose File" button and select your resume in PDF or Word format.