Online Application

To apply, please complete this form and click the submit button at the end.

*All Fields Required

Application for Employment

Date: Social Security #: Home Phone:

Name: Last First M.I. Cell Phone:

Address: Email:

City: State: Zip:

How long have you lived at the address listed above:

If less than 7 Years list all states/counties residence for the past 7 years:

Have you ever filed an application with Keena before? If so, when?

Are you eligible to work in the United States?  Yes  No

Are you UNDER 18 years of age?  Yes  No - If yes, you will be required to provide working papers.

Current Job Status: Employed: Full Time Part Time Unemployed

Are you available to work: Full time Temporary Part time

Date Available for work:

Salary Requirements: $ per year or $ per hour

Shift/Hours Available: Please indicate your preferences by writing "1" for your first choice, "2" for your second choice and "3" for your third choice. 1st Shift (Typically 7AM - 3PM, or 8AM - 5PM) 2nd Shift (Typically 3PM - 11PM) 3rd Shift (Typically 11PM - 7AM)

Days available: Mon, Tues, Wed, Thurs, Fri, Sat, Sun {Overtime, if needed Yes No}

Method of transportation: Personal Vehicle Public Transportation

Type of work you are interested in: (check as many as you are interested in) Accounting General Labor Administrative/Clerical Maintenance/Landscaping Computer/IT Manufacturing Customer Service Medical Assembly Data Entry Other

Please list any licenses/certifications:

Please check areas where you would be willing to work: Argyle Glens Falls Hudson Falls Granville Greenwich Saratoga South Glens Falls Queensbury Other

Education

Last Year Completed Did you Graduate? School Name Subject studied/Degree(s) High School 1 2 3 4 Yes No College 1 2 3 4 Yes No Other Schools 1 2 3 4 Yes No

Employment History

Company 1: Phone: Supervisor:

City & State From To

Job Title/ Duties:

Reason For Leaving:

Salary:

Company 2: Phone: Supervisor:

City & State From To

Job Title/ Duties:

Reason For Leaving:

Salary:

Company 3: Phone: Supervisor:

City & State From To

Job Title/ Duties:

Reason For Leaving:

Salary:

Company 4: Phone: Supervisor:

City & State From To

Job Title/ Duties:

Reason For Leaving:

Salary:

*May we contact your current employer?  Yes No

Indicate skills learned at previous jobs: Accounts Payable Executive Secretary Medical Secretary Accounts Receivable Extrusion Payroll Answer Phones # of Lines Fax Operation Plumbing Assembly Filing Purchasing Auto Repair Fork Lift Operation Quality Control Carpentry General Labor Residential Electrical Cashier General Ledger Sales Collating Heavy Equipment Security Commercial Electrical Human Resources Sewing Construction HVAC Shipping & Receiving Conversion Janitorial Switchboard Copier Operation Landscaping Transcription Customer Services Legal Secretary Typing - WPM Data Entry Machine Operator Warehouse Editing Machine Maintenance Welding

Explain any period of time not accounted for in your employment record:

How much can you lift on a regular basis? 10-30lbs 30-70lbs 70-90lbs 90+lbs

Have you ever been convicted of a felony or misdemeanor? Yes No *You will not be denied employment solely because of a conviction record, unless the offense is related to the job for which you have applied. If Yes, for each conviction indicate date of conviction, nature of charge.

Computer Experience (If applicable, please indicate present skill level) Microsoft Excel Beginner Intermediate Expert Microsoft Word Beginner Intermediate Expert Microsoft Access Beginner Intermediate Expert Microsoft PowerPoint Beginner Intermediate Expert Microsoft Outlook Beginner Intermediate Expert QuickBooks Beginner Intermediate Expert

How did you hear of Keena? Sources Name: Sources Employer:

Special Skills or Qualifications: Summarize special job-related qualifications acquired from employment & other experience

Signed Date

I certify that the answers given herein are true and complete to the best of my knowledge. I understand that false or misleading information given in my application and/or interview(s) is grounds for refusing to hire me, or for discharge should I be hired. 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 hereby understand and acknowledge that, unless otherwise defined by applicable law, any employment relationship with this organization is of an "at will" nature, which means that the Employee may resign at any time and the Employer may discharge Employee at any time with or without cause. It is further understood that this "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.

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