Online Application

To apply, please complete this form and click the submit button at the end.
APPLICATION FOR EMPLOYMENT
NAME (First, Last, Middle Initial):
DATE:
ADDRESS (Street, Apt. #):
PHONE:
CITY, STATE, ZIP CODE:
ALT PHONE:
How long have you lived at this address? If less than 2 years, please list other addresses below.
Other:
Length of Time:
(Address, City, State and Zip)
E-MAIL ADDRESS:
 

ARE YOU AT LEAST 18 YEARS OF AGE: YES     NO
If NO, can you supply working papers? YES     NO
AVAILABLE TO WORK:
Full Time
Part Time
Seasonal

DATE AVAILABLE:
EMPLOYMENT STATUS:
Unemployed
Full Time Employed
Part Time Employed
Seasonally Employed
EDUCATION (School Name, City, State): HIGHEST LEVEL or DEGREE OBTAINED: DID YOU GRADUATE?
Yes
No
Yes
No
LIST ANY CERTIFICATIONS OBTAINED THAT ARE WORK RELATED (Example: Emergency Medical Technician and expiration dates, applicable:
HOW DID YOU HEAR ABOUT KEENA? 
Employee Referral Client Referral Keena Web Page Other Web Page Help Wanted Sign
Other
SKILLS, EXPERIENCE AND EMPLOYMENT INTERESTS - Check ALL that apply
Accts/Payable-Receivable
Administrative
Accountant
Accounting
Auto Repair
Banking/Finance
Bookkeeper
CDL
Carpentry
Cashier
Cook/Chef
Construction
Driver / Cab / Other
Editing
EMS
Electrical/Electrician
Restaurant-Wait Staff
Fund Raising or Non-Profit
Graphic Resources/Arts
Human Resources
Hospitality
Insurance
IT/Computer
Laborer/Janitorial
Landscaping
Legal Field
Machine Operator
Machinist
Maintenance
Management
Manufacturing
Marketing
Mechanic
Medical Field/RN/other
Medical Assembly
Painting
Payroll
Plumbing
Purchasing
Receptionist
Retail
Sales Professional
Secretary
Warehouse
Fluent 2nd Language
COMMENTS
DESIRED SALARY LEVEL     $ Per Hour  OR  $Annual
Are you eligible to work in the United States and able to provide proof upon hire? Yes    No
What shifts would you prefer to work?  (Rate 1, 2, 3 in order of preference).
1st Shift – 7am-3pm or 8am-5pm
2nd Shift – 3pm-11pm
3rd Shift – 11pm-7am
EMPLOYMENT HISTORY (Indicate most recent first.)
Employer/Company Name:
Telephone No.
Supervisor’s Name:
Address, City, State, Zip:
Length of Time:
Job title and Duties:
Dates Employed:
From:
To:
Reason for Leaving:
May we contact this employer?
Yes    No
Salary or Hourly Rate of Pay:
$
 
Employer/Company Name:
Telephone No.
Supervisor’s Name:
Address, City, State, Zip:
Length of Time:
Job title and Duties:
Dates Employed:
From:
To:
Reason for Leaving:
May we contact this employer?
Yes    No
Salary or Hourly Rate of Pay:
$
 
Employer/Company Name:
Telephone No.
Supervisor’s Name:
Address, City, State, Zip:
Length of Time:
Job title and Duties:
Dates Employed:
From:
To:
Reason for Leaving:
May we contact this employer?
Yes    No
Salary or Hourly Rate of Pay:
$
 
Employer/Company Name:
Telephone No.
Supervisor’s Name:
Address, City, State, Zip:
Length of Time:
Job title and Duties:
Dates Employed:
From:
To:
Reason for Leaving:
May we contact this employer?
Yes    No
Salary or Hourly Rate of Pay:
$
COMPUTER SKILL BASE
WORD Beginner Intermediate Expert
EXCEL Beginner Intermediate Expert
QUICKBOOKS Beginner Intermediate Expert
ACCESS Beginner Intermediate Expert
POWERPOINT Beginner Intermediate Expert
OUTLOOK Beginner Intermediate Expert
OTHER Beginner Intermediate Expert
OTHER Beginner Intermediate Expert
PHYSICAL SKILLS  (answer only if it pertains to job skills/requirements for which you are seeking)
Ability to lift consistently  10-30 lbs   30-70 lbs   70-90 lbs   90+ lbs
TRANSPORTATION AVAILABILITY
Personal Vehicle
Public Transportation
Mon  Tue  Wed  Thu  Fri  Sat  Sun
Overtime Yes     No
ADDITIONAL INFORMATION, SKILLS OR SUMMARY
EMPLOYEE SIGNATURE, RELEASE AND UNDERSTANDING POLICY STATEMENT
I certify that the information I provided on this application and any supporting documentation, and will provide throughout the hiring process is true, accurate and complete.  I understand that providing false, misleading, or incomplete information is grounds for denial or termination of employment, regardless of the timing or circumstances of discovery.  I also authorize investigation of all statements contained in this application for employment as may be necessary in arriving at an employment decision.  I understand and agree that I may be required to pass one or more of the following: Physical Examination, Drug Screen, Respiratory Evaluation, Credit Check, and Criminal Record Check, as a condition of hiring or continued employment.  I also understand and acknowledge that, should an offer of employment be extended, that employment will be "at will" for no specified duration and may be terminated by myself or Employer at any time with or without cause. It is further understood that neither this application, any statements made by any Employer representatives, nor any offer of employment constitutes an employment contract and that the "at will" employment relationship may not be changed by any written documentation or by conduct unless an authorized executive of this organization specifically acknowledges such change, in writing. In the event of employment, I understand, also, that I am required to abide by all rules and regulations of the Employer/Keena. 

****ATTENTION –  Placement Services****

I understand should I secure placement by KEENA and the assignment ends, I will be ineligible for unemployment insurance benefits unless I am ready, willing and able to work, which could include accepting another assignment of suitable work from KEENA. Should I decline such an assignment, or fail to respond to communication from KEENA regarding such an assignment, I may be ineligible for unemployment insurance benefits. 

According to the NYS Dept of Labor’s Unemployment Insurance Handbook (p. 8) “Suitable work is work for which you are reasonably fitted by training and/or experience. This means that you have to look for work in all your recent occupations, especially if the prospect of obtaining work in your primary skill area is not good. You are required to look for and be prepared to accept employment that pays the prevailing wage for similar work even if this is less than you earned on your last job or less than the salary you would like to receive.”

Signature: Date: 



A copy of your Application will be sent to your email address.


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KEENA Staffing
2 Progress Blvd. • Queensbury, NY12804
518-793-9825 • Fax 518-793-0224

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