JOHN BOOS & CO.Application For Employment Please print or type. The application must be

fully completed to be considered. Complete each section, even if you attached a resume.

Personal Information Name

Address City State Zip

Phone Number Email Address

Are you legally eligible to work in the US?

Yes No

If selected for employment are you willing to submit to a background check?

Yes No

Position Position Available Start Date Desired Pay

Employment Desired

Full Time Part Time Seasonal/Temporary

Education School Name Location Years Attended Degree Received Major

References (Business and Professional Only) Name Title Company Phone

No

John Boos & Co. is an Equal Opportunity Employer.

Are you a veteran?

Yes

3601 S Banker St Effingham, IL 62401 (217) 347-7701

Are you 18 years or older?

Yes No

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Employment History (Start with your present or most recent employment and work back.)

Employer (1) Job Title Dates Employed

Work Phone

Address City State Zip

Employer (2) Job Title Dates Employed

Work Phone

Address City State Zip

Employer (3) Job Title Dates Employed

Work Phone

Address City State Zip

Employer (4) Job Title Dates Employed

Work Phone

Address City State Zip

Signature Disclaimer I certify that all the information submitted by me on this application is true and complete, and I understand that if any false information, omissions, or misrepresentations are discovered, my application may be rejected and, if I am employed, myemployment may be terminated at any time.

Name (please print) Signature

Date

General Special Skills, Certifications, Licenses:

Activities: (Civic, Athletic, Volunteer, Etc.)

US Military or Naval Service: Rank: Present Membership in National Guard or Reserves:

Duties Reason for Leaving

Duties

Duties

Duties

Reason for Leaving

Reason for Leaving

Reason for Leaving

John Boos & Co. is an Equal Opportunity Employer

It is the company’s policy to abide by all laws pertaining to fair employment practicesand to not discriminate against any employee or applicant for employment because ofrace, color, religion, age, sex, national origin, or ancestry. The same principles apply tothe hiring of any disabled person unless the disability is directly related to job performance.

As an applicant, you should understand and agree to the following:

I hereby declare the information provided by me in this application is true and complete,and I understand that any falsification of this information or omission of information isgrounds for refusal to hire, or termination, if hired.

I understand that I must be legally authorized to work in the United States and the statein which I am applying (i.e. meet employment eligibility requirements under theImmigration Reform and Control Act of 1986; meet applicable minimum age requirements,etc.). I understand that I will be required to submit sufficient documentation or take certainsteps to comply with these laws.

I authorize any of the persons or organizations referenced in this application to give youany and all information concerning my previous employment, education, or any otherinformation they might have with regard to any of the subjects covered by this application,and I release all such parties from all liability for any damage which may result fromfurnishing such information to you.

I authorize you to request, receive and verify all information given in this application.

I HAVE READ AND FULLY UNDERSTAND THE PRECEDING STATEMENTS.

Date: _____________________ Signature: _______________________________