Employee Application - Personal Information

Chateau Girardeau is an equal opportunity employer, dedicated to a policy of non-discrimination on any basis, including race, creed, age, sex, religion, national origin, disability or veteran status.

In order that your application may properly be evaluated, it is essential that all of the following questions be answered carefully and completely. Please feel free to attach a resume as a supplement to this application.

Press the Submit button when you have completed your application.

Personal Information

Position(s) Applied for: Date:

Are you over age 18?
First Name: Last Name: MI:
Street Address: City: State:
Zip: Telephone (Home): Telephone (Other):
Email: (Type N/A if no email address): Preferred method of contact:

Best time to contact you:

Are you applying for:

Shift Preference:    

Is there anything that can prevent you from doing this job?

Do you have any relatives or friends employed in this facility?
Friend's/Relative's Names

Have you ever been employed by this facility? 
If yes, which department?

Dates of Employment:
Are you a U.S. Citizen or an alien legally authorized to work in the U.S.? 

Have you ever been convicted of, plead guilty to or entered a plea of nolo contendere to any Felony or Misdemeanor? 

If yes, what type of offense?

Was it expunged? If yes, how long ago?

Have you ever been discharged or forced to resign for any reason from a job?

If yes, give the name of the employer, date and reason in each case:

Did you ever serve in the U.S. Armed Forces?
If yes, which branch? Dates of Service?

Note: zeros and O's are clearly marked.

Want to learn more?

Note: zeros and O's are clearly marked.