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Last Name
*
First Name
*
Middle Name
Other Surname?
Street Address
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City
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State
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Zip Code
*
Preferred Phone #
*
Second Phone #, if any
SSN (optional)
E-Mail Address
*
Driver License #
*
Class of License
*
License State
*
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Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
License Expiration Date
*
Today's Date
*
Position Applied For :
*
Are you seeking
*
Full-Time
Part-Time
Temporary
When could you start?
*
Have you read the Essential Job Functions of the job for which you’re applying?
*
Yes
No
Can you perform the Essential Job Functions of the job for which you’re applying (with or without
accommodation)?
*
Yes
No
Are you legally authorized to work in the United States?
*
Yes
No
Have you ever applied here before?
*
Yes
No
If yes, when?
Were you ever employed here before?
*
Yes
No
If yes, when?
Education
High School
College
Trade School
Other
High School
Name of School
*
City/State
*
Level Completed
*
Course of Study
*
College
Name of School
*
City/State
*
Level Completed
*
Course of Study
*
Trade School
Name of School
*
City/State
*
Level Completed
*
Course of Study
*
Other
Name of School
*
City/State
*
Level Completed
*
Course of Study
*
List three references who are not relatives or former employers:
Name
*
Address
*
Phone Number
*
Name
*
Address
*
Phone Number
*
Name
*
Address
*
Phone Number
*
List employers in chronological order with current or last employer listed first. Account for all periods of time including military service and periods of unemployment
Employer 1
Name of Employer
*
Job Title and Duties
*
Dates of Employment (MO / YY)
*
Supervisor
*
Telephone Number
*
Address
*
City, State, Zip
*
Reason for Leaving
*
Employer 2
Name of Employer
Job Title and Duties
Dates of Employment (MO / YY)
Supervisor
Telephone Number
Address
City, State, Zip
Reason for Leaving
Employer 3
Name of Employer
Job Title and Duties
Dates of Employment (MO / YY)
Supervisor
Telephone Number
Address
City, State, Zip
Reason for Leaving
I have read and fully understand the foregoing statements. I seek employment under these conditions.
Describe any training or skills you have, or equipment you can operate, related to the job for which you are applying
*
PLEASE READ EACH STATEMENT CAREFULLY BEFORE SIGNING
I certify that all information provided in this employment application is true and complete. I understand that any false information
or omission may disqualify me from consideration for employment and may result in my dismissal if discovered at a later day.
I authorize the investigation of any or all statements contained in this application. I also authorize, whether listed or not, any
person, school, current employer, past employers and organizations to provide relevant information and opinions that may be useful
in making a hiring decision. I release such persons and organizations from any legal liability in making such statements.
I understand that I may be required to successfully pass a drug screening examination. If required, I hereby consent to a pre- and/or
post- employment drug screen as a condition of employment.
I understand that if I am extended an offer of employment it may be conditioned upon my successfully passing a complete pre-
employment physical examination. I consent to the release of any or all medical information as may be deemed necessary to judge
my capability to do the work for which I am applying.
IF I AM EMPLOYED AT PEERLESS, I ACKNOWLEDGE THAT THERE IS NO SPECIFIED LENGTH OF EMPLOYMENT AND THAT THIS APPLICATION DOES NOT CONSTITUTE A CONTRACT FOR EMPLOYMENT. ANY SUCH EMPLOYMENT AGREEMENT MUST BE IN WRITING AND SIGNED BY BOTH THE PRESIDENT OF PEERLESS AND THE EMPLOYEE. ACCORDINGLY, EITHER I OR PEERLESS CAN TERMINATE MY EMPLOYMENT AT WILL, AT ANY TIME, WITH OR WITHOUT CAUSE.
Application Signature
*
Date
*
An Equal Opportunity Employer
We do not discriminate on the basis of race, color, religion, national origin, sex, age, disability, or any other status protected by law or regulation. It is our intention that all qualified applicants be given equal opportunity and that selection decisions be based on job related factors.
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Westy North
8080 North Sheridan Blvd
Arvada, CO 80003
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Brighton
1212 Bridge St.
Brighton, CO 80601
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Broomfield
11985 Teller St
Broomfield, CO 80020
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Canon City
3135 Highway 50 East
Canon City, CO 81212
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S. Tejon
1104 S. Tejon
Colorado Springs, CO 80903
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Fillmore
801 E. Fillmore St
Colorado Springs, CO 80907
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North Academy
6730 N Academy Blvd
Colorado Springs, CO 80918
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East Colfax
4860 East Colfax
Denver, CO 80220
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Durango
1990 N Main
Durango, CO 81301
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Golden
17204 S Golden Rd
Golden, CO 80401
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Greeley
1105 11th Ave
Greeley, CO 80631
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Highlands Ranch
5848 E County Line Road
Highlands Ranch, CO 80126
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Green Mountain
12009 W. Alameda
Lakewood, CO 80228
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South Lakewood
1899 S Sheridan Blvd.
Lakewood, CO 80232
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Longmont
1380 South Main
Longmont, CO 80501
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Loveland
2216 N Lincoln Ave
Loveland, CO 80538
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Northglenn
11490 Huron
Northglenn, CO 80234
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Pueblo South
1301 S Prairie
Pueblo, CO 81005
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Pueblo North
2906 N Freeway
Pueblo, CO 81008
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Englewood
4301 S Santa Fe Dr
Sheridan, CO 80110
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Thornton
8021 N Washington
Thornton, CO 80229
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Westy
3434 W 72nd Ave
Westminster, CO 80030
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Emporia
2920 West US Highway 50
Emporia, KS 66801
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Garden City
1811 East Kansas Plaza
Garden City, KS 67846
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Hays
2000 Vine St
Hays, KS 67601
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Hutchinson
1105 East 30th Ave
Hutchinson, KS 67502
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Junction City
621 West 6th St
Junction City, KS 66441
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North 3rd St
1001 North 3rd St
Manhattan, KS 66502
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Anderson
2829 Anderson Ave
Manhattan, KS 66502
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Salina
680 S Front St
Salina, KS 67401
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Kansas Ave
333 Kansas Ave
Topeka, KS 66603
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Huntoon
4214 Huntoon St
Topeka, KS 66604
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Topeka Blvd
3519 SW Topeka Blvd
Topeka, KS 66611
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Wichita
5730 W Central Ave
Wichita, KS 67212
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Gering
3410 N 10th St
Gering, NE 69341
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San Mateo
3321 San Mateo Blvd NE
Albuquerque, NM 87110
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Albuquerque NW
5801 4th St NW
Albuquerque, NM 87107
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Albuquerque Central
7408 Central Ave SW
Albuquerque, NM 87121
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Albuquerque Eubank
241 Eubank Blvd. NE
Albuquerque, NM 87123
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Farmington
2401 East Main
Farmington, NM 87401
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Sante Fe
3010 Cerrillos Rd
Sante Fe, NM 87507
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Rapid City
1221 East St. Joseph
Rapid City, SD 57701
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Rapid City West
1029 Jackson Blvd
Rapid City, SD 57702
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Amarillo Blvd
2401 E Amarillo Blvd
Amarillo, TX 79107
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Amarillo Western
3339 S Western
Amarillo, TX 79109
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Lubbock
2302 50th St
Lubbock, TX 79412
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Midland
2804 West Wall St
Midland, TX 79701
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Odessa
3401 Andrews Hwy
Odessa, TX 79762
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San Angelo
1520 N Bryant Blvd
San Angelo, TX 76903
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Casper East
1570 E Yellowstone
Casper, WY 82601
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Casper
2929 Cy Ave
Casper, WY 82604
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Cheyenne South
1904 E Lincoln Way
Cheyenne, WY 82001
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Laramie
857 N 3rd St
Laramie, WY 82072
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Sheridan
2107 N Main
Sheridan, WY 82801
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