Threshold ENTERPRISES, LTD. 23 Janis Way Scotts Valley, CA 95066 We appreciate your interest in Threshold Enterprises, Ltd. Threshold is an equal employment opportunity employer. The Company s policy is not to discriminate against any applicant or employee based on race, color, sex, religion, national origin, age, disability, or any other basis protected by applicable federal, state or local laws. Threshold also prohibits harassment of applicants or employees based on any of the protected categories. It is also Threshold s policy to comply with all applicable state and federal laws respecting consideration of unemployment status in making hiring decisions. Application for Employment Please print clearly. Only complete applications will be considered. Personal Information Today s Date: / / First Name Middle Name Last Name _ Home Phone Cell Phone Work Phone Best time to call you _ Best number to reach you _ Email Address: Have you ever been employed by us before? If yes, give dates: Position held: Reason for leaving: Rate of pay: Have you ever worked at Threshold through a temporary agency? If yes, what agency? Give dates: Do you have any relatives working at Threshold? If yes, provide name(s) and department(s): _ Employment Desired Position(s) Applying for:,, How did you hear about the position(s) that you are applying for? _ Date available to start work: Type of employment desired: _Full-time _Part-time _Temporary Shift: _Day _Swing Night Days of the week: _Sun _ Mon _Tue _ Wed _ Thu _ Fri _ Sat
Availability and Work Requirements Would you be available to work overtime, if necessary?... If hired, would you have reliable means of transportation to and from work?... Will you now or in the future require sponsorship for employment visa status (e.g. H-1B status)?... If hired, can you present proof of your legal right to work in this country?... Are you at least 18 years old?... Have you ever used any other name(s) which is (are) necessary for us to know in order for us to verify your employment or education records?... If yes, please provide the other name(s): Are you able to perform all of the essential functions of the position for which you have applied for, with or without a reasonable accommodation?... If no, please explain: Have you ever been convicted of a crime?... Note: Conviction of a crime is not an automatic bar to employment all circumstances will be considered. (Convictions for marijuana-related misdemeanors that are more than two years old need not be listed.) California Applicants: Do not identify any misdemeanor conviction for which probation has been successfully completed or otherwise discharged and the case has been dismissed by a court. Also, do not identify marijuana-related convictions entered by the court more than 2 years ago that involve: unlawful possession of marijuana; transportation or giving away of up to 28.5 grams of marijuana, other than concentrated cannabis, or the offering to transport or give a way up to 28.5 grams of marijuana, other than concentrated cannabis; possession of paraphernalia used to smoke marijuana; being in a place with knowledge that marijuana was being used; or being under the influence of marijuana. Also, do not identify any arrest or detention that did not result in a conviction or any record of a referral to, and participation in, any pre-trial or post-trial diversion program. If yes, state nature of the crime(s), when and where convicted and disposition of the case:
Employment History Please complete this section even if attaching a resume. Attach additional pages if necessary. List below all present and past employment for the last 5 years starting with your most recent employer. / / to / / Starting Pay $ Ending Pay $_ Supervisor s Name Phone Number _ May we contact this employer for a reference? / / to / / Starting Pay $ Ending Pay $_ Supervisor s Name Phone Number _ May we contact this employer for a reference? / / to / / Starting Pay $ Ending Pay $_ Supervisor s Name Phone Number _ May we contact this employer for a reference? Please explain any gaps in employment:
Education School or Branch Name and Address High School # Of Years Completed Did You Graduate? Degree/Diploma/Certificate Earned College/University Military Branch Rank: Status: Other Other Please list any other job-related skills that you would like us to consider during our evaluation of your application:
Work-Related References List below three people not related to you that can attest to your work experience and job-related performance within the last five years. Number of Years Acquainted: Number of Years Acquainted: Number of Years Acquainted: My initials on each line below indicate that I understand and agree to the following: If I am offered employment, I will, as a condition of employment, be required to submit proof of my identity and legal right to work in the United States. 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 to the questions and statements on this application are true and correct. I hereby authorize Threshold Enterprises, Ltd. (the Company ) to verify all information on this application. I also authorize my former employers and education institutions to give the Company any information they may have regarding me. I further certify that I 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 understand that this application is not, and is not intended to be, a contract of employment, nor does this application obligate the Company to employ me. I understand that nothing contained in this application, or conveyed during any interview is intended to create an employment contract between me and the Company. I understand that if employed, and in consideration of my employment, I agree to conform to the rules and regulations of the Company. I also understand that if I am applying for a position covered by a union contract, then the union contract will govern my employment, to the extent applicable. If I am not applying for a position covered by a union contract, then every aspect of my employment with the Company shall be on an at-will basis, meaning that I or the Company may terminate my employment at any time, for any reason, with or without cause. I further understand that the Company expressly reserves its inherent authority to manage and control the business enterprise and to exercise its sole discretion to determine all issues pertaining to my employment, including all matters pertaining to promotion, job assignment, the size of the workforce, demotion, transfer and discipline. I authorize the investigation of all statements contained in this application and supporting documents. Threshold Enterprises, Ltd. may seek to conduct an investigative consumer report. If so, I understand that I will be asked to sign a separate written authorization. Acknowledgment and Certification I certify that all statements on this application are true and complete to the best of my knowledge. I understand that false or incomplete statements shall be sufficient for disqualification or dismissal. / / Date Applicant s Signature