Careers Application

Please fill out the application below and click send. Once we receive your application, it will be reviewed. If you meet qualifications, we will contact you. Thank you!

PERSONAL INFORMATION

First Name (required)

Middle Name (optional)

Last Name (required)

Primary Phone (required)

Primary Email (required)

Address (required)

City (required)

State (required)

Zip (required)

Is your age Under 18? (required)
YesNo

If so, what is your age?

Sex/Gender (optional)
FemaleMale

Today's Date (required)

Are you a U.S. Citizen or otherwise legally entitled to work in the U.S.? (required)
YesNo

Racial/Ethnic Heritage (optional): WhiteHispanic or LatinoBlack or African AmericanAsianNative Hawaiian or Other Pacific IslanderAmerican Indian or Alaska NativeTwo or More Races

Veterans Status (optional): I am NOT a veteran of the U.S. Armed ForcesI am a veteran of the U.S. Armed ForcesI am a Vietnam Era Veteran*I am a spouse of a disabled wartime veteran whose disability is at least 70% and is traceable to war serviceI am an un-remarried spouse of a veteran killed in action or a veteran who died of a service-connected disability

*For federal reporting purposes, a Vietnam Era Veteran is defined as a veteran, any part of whose active military, naval, or air service was during the period of August 5, 1964, through May 7, 1975 who (a) served on active duty for a period of more than 180 days and was discharged or released there from with other than a dishonorable discharge or (b) was discharged or released from active duty because of a service-connected disability.

EMPLOYMENT DESIRED

For which position are you applying (required)

Wage Desired Per Hour (required)

Work Desired (required)
Full TimePart Time

Shift Desired (required)
1st2nd3rdWeekend

Choose the Location Applying For:

EDUCATION

Name of High School:

Courses Majored In:

Year Completed:
9101112

Graduated?:
YesNo

Name of College:

Courses Majored In

Year Completed:
123456

Graduated?:
YesNo

Name of College:

Courses Majored In

Year Completed:
123456

Graduated?:
YesNo

PREVIOUS WORK HISTORY

You may upload a resume in place of filling out the Work History section.

Would you like to:
Upload ResumeFill out the work history section

The attachment can be sent in the following formats: (.doc, .docx, .pdf) and must not exceed 2 megabytes.

PREVIOUS WORK HISTORY - List your most recent employment first:

PRESENT OR LAST Employer:

City, State:

Phone:

Date Hired:

Date Left:

Name of Supervisor:

Description of Duties:

Reason for Leaving:

PREVIOUS Employer:

City, State:

Phone:

Date Hired:

Date Left:

Name of Supervisor:

Description of Duties:

Reason for Leaving:

PREVIOUS Employer:

City, State:

Phone:

Date Hired:

Date Left:

Name of Supervisor:

Description of Duties:

Reason for Leaving:

PREVIOUS Employer:

City, State:

Phone:

Date Hired:

Date Left:

Name of Supervisor:

Description of Duties:

Reason for Leaving:

PLEASE ANSWER THE FOLLOWING QUESTIONS:

Can you perform the essential functions of the job for which you are applying with or without reasonable accommodations?
YesNo

Please state the reasonable accommodations required, if any.

Can you accept a job immediately?
YesNo

If not, how soon?

Have you ever worked here before?
YesNo

If so, when?

Have you ever applied here before?
YesNo

If so, when?

Do you have friends or relatives working here?
YesNo

If so, who?

Have you ever been discharged from any jobs?
YesNo

If so, give reason:

What job qualifications, skills or professional certificates do you possess?

May we contact your present employer?
YesNo

Your previous employers?
YesNo

HOW DID YOU HEAR ABOUT US? (required)

NewspaperRadioBehlen WebsiteSocial MediaLinked InWorkforce DevelopmentPartner in Progress ReferralWalked InOther

Partner in Progress who referred you?

Other:

AN EQUAL OPPORTUNITY EMPLOYER

Behlen is an Equal Opportunity Employer and fully ascribes to the principles of Equal Employment Opportunity.

APPLICANT’S STATEMENT AND AGREEMENT

(Read carefully the following statements and agreement before clicking the send button.)

1. “I certify that the information contained in this Application is correct to the best of my knowledge, and understand that falsification of this application in any details is grounds for disqualification from further consideration or for dismissal from employment in accordance with company policy. I agree to conform to the rules and regulations of the company, and understand that my employment and compensation can be terminated, with or without cause, and with or without notice, at any time, at the option of either the company or myself.”

2. I authorize my former employers and any other persons or organizations to provide any accurate and current information they have about my background, and I release all concerned from any liability in connection therewith.

3. I understand that unless acted upon, this application will become inactive after 60 days.