Pipeline Newport Beach

Pipeline Newport Beach – An Equal Opportunity Employer

Application for Employment

 
Saturday, April 1, 2023 
Name (last, first and middle)
Present street address
 City
 State
 ZIP Code
Mailing address (if different from above)
 City
 State
 ZIP Code
Email address
 Home phone
 Message or cell phone
Position applying for
 Salary desired
 Date you can start
How were you referred to us? (check one)     Newspaper advertisement     Walk-in     Other
Are you applying for:
Full time  Part time  Temporary		 Location:
Pipeline Newport Beach   North Shore Shave Ice
Shifts you are available: (check all that you can work)
Monday  Tuesday  Wednesday  Thursday  Friday  Saturday  Sunday  Days only  Nights only  Any time
Have you ever worked for us before?
Yes     No
If yes, where?
If yes, when? 		Are you at least 18 years old?
Yes     No
If under 18, hire is subject to verification that you are of minimum legal age.
If hired, can you present evidence that you have the legal right to work in the US?     Yes    No
Are you able to perform the essential functions of the job for which you are applying with or without reasonable accomodation?  Yes  No
If no, please describe the functions that cannot be performed:

Note: We comply with ADA and consider reasonable accommodation measures that may be necessary for eligible applicants/employees to perform the essential functions.

EDUCATION HISTORY
 
Name & Location		 # Years
Attended		 Did you
graduate?		 Courses/Degree
High School
College
Graduate School
Trade School

SKILLS
Language: Speak  Read  Write     Level: Fair  Good  Fluent
Language: Speak  Read  Write     Level: Fair  Good  Fluent
Office Skills:   Typing - WPM   Shorthand   Calculator/Ten Key
Computer Skills:   Excel   Word   Other:
Please list any special skills, training or education that may be applicable to the position you are applying for:

PREVIOUS EXPERIENCE - List your previous employers, starting with the most recent
Name/Address
 Start
Date		 Final
Date		 Final
Salary		 Title/
Position		 Description
of work
Reason for leaving
Supervisor   May we contact? Yes No     Phone #
Name/Address
 Start
Date		 Final
Date		 Final
Salary		 Title/
Position		 Description
of work
Reason for leaving
Supervisor   May we contact? Yes No     Phone #
Name/Address
 Start
Date		 Final
Date		 Final
Salary		 Title/
Position		 Description
of work
Reason for leaving
Supervisor   May we contact? Yes No     Phone #
Name/Address
 Start
Date		 Final
Date		 Final
Salary		 Title/
Position		 Description
of work
Reason for leaving
Supervisor   May we contact? Yes No     Phone #

BUSINESS REFERENCES - List three references who are not relatives or personal friends
Name/Relationship Title Company Name Phone

MILITARY SERVICE
Describe any military service skills that may be relevant to the job you are applying for

AUTHORIZATION

Before sending your application, please take a moment to make sure you have completed all of the questions. Failure to complete all of the questions may delay or prevent the processing of your application. By pressing the button below you are stating that you have read and understand the foregoing and agree unconditionally to the foregoing:

I hereby certify that I have not knowingly withheld any information that might adversely affect my chances for employment and that the answers given by me are true and correct to the best of my knowledge. I further certify that I, the undersigned applicant, have personally completed this application. I understand that any omission or misstatement of material fact on this application or on any document used to secure employment shall be grounds for rejection of this application or for immediate discharge if I am employed, regardless of the time elapsed before discovery.

I hereby authorize the company to thoroughly investigate my references, work record, education and other matters related to my suitability for employment and, further, authorize the references I have listed to disclose to the company any and all letters, reports and other information related to my work records, without giving me prior notice of such disclosure. In addition, I hereby release the Company my former employers and all other persons, corporations, partnerships and associations from any and all claims, demands or liabilities arising out of or in any way related to such investigation or disclosure.

I understand that nothing contained in the application, or conveyed during any interview which may be granted or during my employment, if hired, is intended to create an employment contract between me and the company. In addition, I understand and agree that if I am employed, my employment is for no definite or determinable period and may be terminated at any time, with or without prior notice, at the option of either myself or the Company, and that no promises or representations contrary to the foregoing are binding on the Company unless made in writing and signed by me and the company’s designated representative.

Should a search of public records (including records documenting an arrest, indictment, conviction, civil judicial action, tax lien or outstanding judgment) be conducted by internal personnel employed by the Company I am entitled to copies of any such public records obtained by the Company. If I am not hired as a result of such information, I am entitled to a copy of any such records.