Employment

Application for Employment with ShieldWorks

136 Hud Road Winchester, KY 40391 (859) 887-1776

ShieldWorks is an equal opportunity employer and does not discriminate against otherwise qualified applicants on the basis of race, color, creed, religion, ancestry, age, sex, marital status, national origin, disability, or handicap, or veteran status.
Date of Application*
Date Format: MM slash DD slash YYYY
Position(s) Applied For*
Referral Source
- Friend
- Relative
- Walk-In
Name*
Email*
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Phone*
Are you 18 years of age or older?
- Yes
- No
Have you completed an application here before?
- Yes
- No
If yes, give date
Date Format: MM slash DD slash YYYY
Have you ever worked for ShieldWorks before?
- No
- Yes
If yes, give date
Date Format: MM slash DD slash YYYY
Are you employed now? If yes, may we contact your employer?
- No
- Yes
May we contact your employer? (List Name & Phone Number)
Are you legally eligible for employment in the United States?
- Yes
- No
(If offered employment, you will be required to provide documentation to verify eligibilty.)
On what date would you be available to work?*
Date Format: MM slash DD slash YYYY
What language(s) do you speak and write fluently?
Are you available to work
- Full Time
- Part Time
- Temporary
Are you on lay-off and subject to recall?
- Yes
- No
Have you been convicted of a felony or misdemeanor for which a jail sentence may be imposed or a crime that relates to the position for which you are applying within the past 7 years?
- No
- Yes
If yes, please explain.
Conviction will not necessarily disqualify applicant from employment.
Are you a veteran of U.S. Military service?
- No
- Yes
If Yes, which branch
Days and Hours Available
Sunday Monday Tuesday Wednesday Thursday Friday Saturday
Are there specific times that you cannot work?
Can you work overtime, including weekends?
- Yes
- No
Do you have any objection to travel?
- No
- Yes
Have you ever been fired or disciplined?
- No
- Yes
Why?
Are you able to perform the essential functions of the job for which you are applying, with or without a reasonable accommodation?
- Yes
- No
If no, please provide explanation.
Are you willing to submit to a physical examination to confirm that you are physically able to perform the physical requirements of the job?
- Yes
- No

Employment History
Date of Employment Employer Name Telephone Address Job Title Job Duties Starting Rate Ending Rate Reason for leaving

Account for any full month since leaving school (high school or college) that you were not working
From (month/year) To (month/year) Reason
Summarize special skills and qualifications from previous experience (attach a resume if applicable)
Education (High School, College, Vocational/Trade School, Graduate School)
Name of School City/State Number of years completed Diploma or Degree Received
References (List at least 3)*
Name Address Phone Number
Comments
This field is for validation purposes and should be left unchanged.

Date of Employment	Employer Name	Telephone	Address	Job Title	Job Duties	Starting Rate	Ending Rate	Reason for leaving

From (month/year)	To (month/year)	Reason

Name of School	City/State	Number of years completed	Diploma or Degree Received

Name	Address	Phone Number

Step 1 of 3

Application for Employment with ShieldWorks