Our People Make Us The BEST!
An equal opportunity employer
We are an equal opportunity employer to the full extent of all applicable laws and do not discriminate on the basis of race, color, religion, national origin, citizenship, sex, age, marital status, height, weight, handicap or any other basis prohibited by law.
First Name Middle Name Last Name
Address City State Zip code
Previous Address City State Zip code
Phone Number Alternate Phone Number
e-mail Address
Social Security No. Driver's License Number
Driver's License state
Position Applied For: Other position:
NOTE: If hired, federal law requires that you furnish documentation proving your identity and eligibility to work in the United States.
Are you currently authorized to work in the United States? Yes No
Are you at least 18 years of age? Yes No
Do you need full-time employment? Yes No
Will you consider part-time? Yes No
Number of hours desired: Per Week Rate of pay: Per Hour Year
Have you ever applied at UMCU before? Yes No Dates: mm/yy - mm/yy
Have you ever worked at UMCU before? Yes No Dates: mm/yy - mm/yy
What other employment or "side line" business do you have?
Would you want to continue this if employed by us? Yes No
Have you ever been convicted of a crime?
Yes No
(A conviction will not automatically bar you from employment.)
If yes list date and details:
How were you referred to us? Explain:
Please place the name of an employee, friend, school, paper, or explanation of other in box above.
Type of School
Name and Location
Dates (mm/yy-mm/yy)
Did you graduate?
Course of Study / Degree
High School Yes No
Technical / Business / Other

Yes No
College or University Yes No
Graduate Work Yes No