Name *

First Name

Last Name

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone *

(###)

###

####

Are you 18 years of age or older? *

YES

NO

Are you a U.S. Citizen or an Alien authorized to work in the United States? *

YES

NO

If applying for a driver or warehouse position, do you have a Class A CDL (Commercial Driver's License)?

YES

NO

Are you Employed now? *

YES

NO

If so, may we contact your current Employer? *

YES

NO

Have you ever applied to Robert "Chick" Fritz, Inc before? *

YES

NO

Did you attend Elementary School (K-8th Grade)? *

YES

NO

Did you attend High School? *

YES

NO

Did you attend a College, Trade Business or Correspondence School? *

YES

NO

U.S. Military Service *

YES

NO

Present Membership in National Guard or Reserves *

YES

NO

Do you have any physical limitations that preclude you from performing any work for which you are applying for?

YES

NO

In Case of Emergency Contact *

First Name

Last Name

Emergency Contact Phone # *

(###)

###

####

Verification of Information Provided *

I certify that the facts contained in this application are true and complete to the best of my knowledge and understand that if employed, falsified statements on this application shall be grounds for dismissal. I authorize investigation of all statements contained herein and the references listed above to give you any and all information concerning my previous employment and any pertinent information they may have, personal or otherwise, and release all parties from all liability for any damage that may result from furnishing same to you. I understand and agree that, if hired, my employment is for no definite period and may, regardless of the date of payment of my wages and salary, be terminated at any time without prior notice.

Yes, I Agree

No, I Do Not Agree

Today's Date *

MM

DD

YYYY