• Full Name
• Address

• City
• State AK AL AR AZ CA CO CT DC DE FL GA HI IA ID IL IN KS KY LA MA MD ME MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA RI SC SD TN TX UT VA VT WA WI WV WY
• Zip Code

• Phone
• Email

• Date Available for Employment

• If employed and under 18, can you furnish a work permit?
• YesNoN/A

• Have you ever been employed by Burton & Mayer, Inc.?
• YesNo

• Are you employed now?
• YesNo

• May we contact your present employer?
• YesNo
• If yes, give name

• Are you prevented from lawfully becoming employed in this country because of Visa or Immigration status?
• YesNo

• Type of work desired

• Can you perform the essential functions of the job(s) for which you are applying?
• YesNo

• Are you able to work (please check all that apply)
• Full-timePart-timeOver-time

• Education - please select highest level completed
• - 4 5 6 7 8 Elementary - 9 10 11 12 High School - 1 2 3 4 College - 1 2 3 4 Graduate School
• School Name & Course of Study (if applicable)

• Summarize special skills and qualifications, volunteer activities, military experience, employment or other activities related to the job you are seeking

• Current or Previous Employer
• Supervisor or Manager Name
• Phone Number
• Your Job Title
• Length of Employment (years, months, etc.)

• Add Attachment (DOC, DOCX, RTF, TXT, PDF, ZIP)

PLEASE READ THE FOLLOWING STATEMENTS CAREFULLY BEFORE SUBMITTING THIS APPLICATION. ONLY THOSE APPLICATIONS THAT ARE SUBMITTED IN THEIR ENTIRETY ARE CONSIDERED VALID. IF YOU HAVE ANY QUESTIONS REGARDING THIS STATEMENT, PLEASE CONTACT THE HUMAN RESOURCES DEPARTMENT BEFORE SUBMITTING.

• I certify that all answers and statements I have made on this application (and resume or other supplementary materials) are true and complete without omissions. I understand that any false information will be grounds for refusal to hire or for immediate discharge if I am employed. I authorize any of the persons or organizations named in this application to give you complete information and records regarding my employment, education, character and qualifications.
• YesNo
• I understand that this application is not an offer of employment and no promises or representations of employment have been made to me at this time.
• YesNo

This information is valid for only ninety (90) days from submission date. If you wish to be considered for job openings more than ninety (90) days from date submitted, you will need to submit a new application. All information contained within this application is handled securely and not release to anyone without written authorization.

• Security Code
•