Employment Application Qualified applicants are considered for all positions without regard to race, color, religion, sex, national origin, age, marital or veteran status.Attach Your ResumeDate of Application (mm/dd/yyyy)* Date Format: MM slash DD slash YYYY When would you be ready to start? (mm/dd/yyyy)* Date Format: MM slash DD slash YYYY Name* First Last Address* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Phone*Email How long have you lived at this address?*What job are you applying for?*Desired rate per hour*How did you learn of this opening?*How many hours a week would you like to work?*Have you ever worked for Summit before?*YesNoIf yes, when?Rate YourselfEnergy Level - your sense of urgency, self-motivation, and enthusiasm*Top PerformerGoodOkImprovement NeededCommunication Skills - your ability to listen well, express ideas clearly and accept feedback*Top PerformerGoodOkImprovement NeededHospitality - your natural friendliness and customer service skills*Top PerformerGoodOkImprovement NeededReliability - your dependability, attendance, self-discipline, and dedication*Top PerformerGoodOkImprovement NeededPersonal Pride - your appearance, hygiene, and achievement*Top PerformerGoodOkImprovement NeededTeamwork - cooperation with others and team spirit*Top PerformerGoodOkImprovement NeededWhat achievements in your life are you most proud of?*What are your personal strengths?*What are your weakest areas?*What are your five-year goals?*Why do you want to work at Summit?*Can you perform the essential functions of this job, with or without accommodations?*YesNoDo you have reliable transportation to work?*YesNoDo you have any relatives or friends currently working for Summit?*YesNoIf yes, state relationship to you and friend/relative:DrivingIn the event you are required to use a company automobile to conduct company business, please complete the following:Do you have a valid drivers license? **YesNoIf yes, indicate State and License Number**Only applicants whose job will involve driving need respond. Ask for details.Past Employment (beginning with most recent)Name of Company*Company Phone #*Company Address* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Employed from (mo/yr)*To (mo/yr)*Title*Duties*Monthly Starting Salary*Monthly Ending Salary*Reason For Leaving*Name of Supervisor*Past Employment #2Name of CompanyCompany Phone #Company Address Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Employed from (mo/yr)To (mo/yr)TitleDutiesMonthly Starting SalaryMonthly Ending SalaryReason For LeavingName of SupervisorPast Employment #3Name of CompanyCompany Phone #Company Address Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Employed from (mo/yr)To (mo/yr)TitleDutiesMonthly Starting SalaryMonthly Ending SalaryReason For LeavingName of SupervisorPersonal References (not former employers or relatives)Name and address*Occupation*Phone*Personal Reference #2Name and address*Occupation*Phone*Personal Reference #3Name and address*Occupation*Phone*Record of EducationName and address of High School*Did you graduate?*YesNoGED?*YesNoGrade Average*College (name and address)Course of studyDid you graduate?YesNoYears completed12345+List DegreeGrade AverageVocational/Technical (name and address)Course of StudyDid you graduate?YesNoYears completed12345+List Diploma/CertificateGrade AverageBackgroundDate of Birth (mm/dd/yyyy)* Date Format: MM slash DD slash YYYY Have you ever been convicted or pled guilty or no contest to any crime involving violence to another person?*YesNoHave you ever been convicted or pled guilty or no contest to any crime involving dishonesty, theft, fraud or embezzlement?*YesNoHave you ever been convicted or pled guilty or no contest to any sexual crime including rape, assault, or involving minors?*YesNoHave you ever been convicted or pled guilty or no contest to any crime involving distribution or intent to distribute illegal drugs or other controlled substances?*YesNoIMPORTANT - READ BEFORE SIGNINGI certify that information given here is true and complete to the best of my knowledge. I understand that incorrect, misleading or incomplete information on this application may result in immediate termination of employment. I understand that this employment application and any other company documents are not contracts of employment and that any individual who is hired may voluntarily leave upon proper notice and may be terminated by the employer at any time and for any reason. I also understand that any oral or written statements to the contrary are expressly disavowed and should not be relied upon by any prospective to existing employee. I understand that the use of illegal drugs is prohibited during employment. If company policy requires, I am willing to submit to drug testing to detect the use of illegal drugs before and during employment.Consent I agree to the above terms.CAPTCHAName*Date (mm/dd/yyyy) Date Format: MM slash DD slash YYYY