HOME // ABOUT // PROJECTS // CAREERS // CONTACT CAREERS EMPLOYMENT APPLICATION * FIRST NAME MIDDLE NAME * LAST NAME * SOCIAL SECURITY NUMBER ADDRESS CITY STATE Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Guam Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virgin Islands Virginia Washington West Virginia Wisconsin Wyoming ZIP LENGTH OF RESIDENCE * EMAIL * CONFIRM EMAIL * PHONE DATE AVAILABLE FOR WORK ARE YOU AT LEAST 18 YEARS OF AGE? Yes No POSITION YOU ARE APPLYING FOR? SALARY REQUIREMENTS ARE YOU ELIGIBLE TO WORK IN THE US? Yes No PRESENTLY EMPLOYED? Yes No DO YOU HAVE A VALID DRIVER'S LICENSE? Yes No ARE YOU WILLING TO TRAVEL? Yes No ARE YOU AVAILABLE TO WORK? Full Time Part Time Shift Work Temporary CERTIFICATIONS/LICENSES APPLICABLE TO THE POSITION APPLYING FOR SKILLS AND QUALIFICATIONS LIST ANY CAREER OBJECTIVES YOU MIGHT HAVE HAVE YOU EVER BEEN CONVICTED OF A FELONY? Yes No (Record of conviction does not necessarily disqualify an applicant from employment conciderations) EDUCATION SCHOOL NAME SCHOOL ADDRESS SCHOOL PHONE NUMBER OF YEARS COMPLETED AREA OF STUDY DID YOU GRADUATE? Yes No Add Another EMPLOYMENT HISTORY Begin with last position first. At least 7 years of work history must be provided. MAY WE CONTACT YOUR PRESENT EMPLOYER? Yes No COMPANY NAME COMPANY ADDRESS COMPANY PHONE SUPERVISOR START DATE END DATE POSITION HELD RATE OF PAY REASON FOR LEAVING Add Another REFERENCES List name. address and phone number of three references, which are not related to you and are not previous employers. NAME ADDRESS PHONE NAME ADDRESS PHONE NAME ADDRESS PHONE UPLOAD FILE Optional – Attach a PDF to your application submission - resume/samples/etc UPLOAD FILE I understand and agree, that any material misrepresentation or deliberate omission of a fact in my application may result in refusal of, or if employed, immediate termination from employment. Although management makes every effort to accommodate individual preference, business needs may at times make the following conditions mandatory: overtime, shift work, rotating work schedule or work schedule other than Monday through Friday. I understand and accept these conditions of my continuing employment. It is my understanding the Gregory Company, Inc. will make a thorough investigation of my entire work history and may verify all data given in my application for employment, related papers or oral interviews. I authorize such investigation and the giving and receiving of any information requested by Gregory Company, Inc., and I release from liability any person giving or receiving such information. I agree that my employment is at will and may be terminated by Gregory Company, Inc. or myself at any time, with or without, notice or cause and without liability for wages or salary, except such as may have been earned at the date of termination. I further understand, that this is an application for employment and that no employment contract is being offered, nor will any result from my employment with Gregory Company, Inc. I understand that if I am employed, such employment is for no definite period of time and that Gregory Company, Inc. can change wages, benefits and conditions at any time within the guidelines of employment law. I acknowledge that any oral representation or written statements, which may have been made to me, to the contrary of this paragraph, are expressly disavowed and may not be relied upon. * SIGNATURE * DATE SIGNED SUBMIT