Roasting Solutions, LLC

10529 Hwy 52 North

Dubuque, IA 52001

Ph: 563.556.3931

Fax: 563.556.2924

Application for Employment

Applicant Note:

All applicants are considered for employment, advancement and earnings based upon their skills, performance and potential without regard to race, color, religion, creed, gender, national origin, age, disability, marital or veteran status, sexual orientation, or any other legally protected status. A felony conviction will not necessarily disqualify an applicant from employment. Please note that your employment at Roasting Solutions, LLC may be affected by the Iowa Smokefree Air Act. Visit the Iowa Department of Public Health’s website, to learn more about the Iowa Smokefree Air Act and how it may affect your employment here.

Roasting Solutions, LLC is an Equal Opportunity Employer

Applicant Information

Full Name:
Last / First / Middle Name.
Address:
Street Address / Apartment/Unit #
City / State / ZIP Code
Phone: / () / 2nd Phone: / ()
Today’s Date: / Date Available For Work:
Work Availability: / Full Time Part Time
Position Applied for:
How Did You Learn About Us: / Newspaper Friend/Relative Name (Optional)
Walk-In
Other
Are you currently employed? / YES / NO / Are you currently on “lay-off” status and subject to recall? / YES / NO
Have you ever worked for this company? / YES / NO / If yes, give date:
Have you ever filed an application with us before? / YES / NO / If yes, give date:
If under the age of 18, can you provide required proof of your eligibility to work? / YES / NO

Education

High School: / Address:
# of Years Completed / Did you graduate? / YES / NO / Degree:
College: / Address:
# of Years Completed / Did you graduate? / YES / NO / Degree:
Other: / Address:
# of Years Completed / Did you graduate? / YES / NO / Degree:

References

Please list three professional references.
Full Name: / Relationship:
Occupation: / Phone: / ()
Address:
Full Name: / Relationship:
Occupation: / Phone: / ()
Address:
Full Name: / Relationship:
Occupation: / Phone: / ()
Address:

Previous Employment

Please list all employers starting with the present.
Company: / Phone: / ()
Address: / Supervisor:
Job Title: / Starting Salary: / $ / Ending Salary: / $
Responsibilities:
From: / To: / Reason for Leaving/Planning to Leave:
Was the separation voluntary or involuntary? (Circle One) / Are you eligible for rehire? Yes No
May we contact your previous supervisor for a reference? / YES / NO
Company: / Phone: / ()
Address: / Supervisor:
Job Title: / Starting Salary: / $ / Ending Salary: / $
Responsibilities:
From: / To: / Reason for Leaving/Planning to Leave:
Was the separation voluntary or involuntary? (Circle One) / Are you eligible for rehire? Yes No
May we contact your previous supervisor for a reference? / YES / NO
Company: / Phone: / ()
Address: / Supervisor:
Job Title: / Starting Salary: / $ / Ending Salary: / $
Responsibilities:
From: / To: / Reason for Leaving/Planning to Leave:
Was the separation voluntary or involuntary? (Circle One) / Are you eligible for rehire? Yes No
May we contact your previous supervisor for a reference? / YES / NO

Military Service

Branch: / From: / To:
Rank at Discharge:

Qualifications

Please list any job-related skills and qualifications acquired from employment or other experience:
Please state any additional information you feel may be helpful to us in considering your application:

Disclaimer and Signature

I certify that answers given herein are true and complete to the best of my knowledge. If this application leads to employment, I understand that false or misleading information in my application or interview may result in my release. I understand, also, that I am required to abide by all rules and regulations of the employer.
I authorize a personal background investigation. I authorize the schools, references, and prior employers to provide any or all information they have concerning me.
This application for employment shall be considered active for a period of time not to exceed 45 days. Any applicant wishing to be considered for employment beyond this time period should inquire as to whether or not applications are being accepted at that time.
I hereby understand and acknowledge that, unless otherwise defined by applicable law, any employment relationship with this organization is of an “at will” nature, which means that they Employee may resign at any time and the Employer may discharge at any time with or without cause. It is further understood that this “at will” employment relationship may not be changed by any written document or by conduct unless such change is specifically acknowledged in writing by an authorized executive of this organization.
Signature: / Date: