Employment Application

It is the policy of BURCO not to discriminate in hiring and employment on the basis of race, color, religion, national origin, sex, disability, age or other protected class as provided by all applicable state and federal laws. It is our intention that all qualified applicants be given equal opportunity and that selection decisions be based on job-related factors.

Answer each question fully and accurately. If you provide false or misleading information during the application process or during your employment with BURCO, this may result in disciplinary action including up to termination of employment or a decision to not consider you further for employment. In reading and answering the following questions, be aware that none of the questions are intended to imply illegal preferences or discrimination based upon non-job-related information. Interviews are scheduled depending on company needs, time availability and employee qualifications.

General Information

Position or Type of Employment Desired *

Have you ever been employed at Burco before? *

Yes No

If yes, when: *

Are you able to perform the essential functions of the job you are applying for, with or without reasonable accommodation? *

Yes No

Date Available *

Salary Desired *

Education and Training

Most recent first, include voluntary work and military experience

Employer *

Address *

Phone Number *

Job title *

Assigned Duties (List at least 5) *

From (Month/Year) *

To (Month/Year) *

Hours Per Week *

Last Salary *

Supervisor *

Reason For Leaving *

May We Contact This Employer? *

Yes No

Employer *

Address *

Phone Number *

Job Title *

Assigned Duties (List at least 5) *

From (Month/Year) *

To (Month/Year) *

Hours Per Week *

Last Salary *

Supervisor *

Reason For Leaving *

May We Contact This Employer? *

Yes No