Call: (413) 598-8215 - 40 Haynes Circle, Chicopee, MA 01020 - Hours: Monday–Friday 7:30AM–4:30PM

Employment Application

Have you ever applied to us before?


Have you ever been employed by us before?


Are you currently employed?


Are you prevented from lawfully becoming employed in this country because of Visa or Immigration Status (proof of citizenship or immigration status will be required upon employment)?


Are you available to work

Full TimePart TimeTemporary

Are you currently on "lay-off" subject to recall?


Can you travel if a job requires it?


Have you been convicted of a felony in the last 5 years?


Languages Spoken


Employment History


Please provide 3 references, including name, contact information and work relation

I certify that answers given herein are true and complete to the best of my knowledge. I authorize investigation of all statements contained in this application for employment as may be necessary in arriving at an employment decision.

This application for employment shall be considered active for a period of time not to exceed 45 days. Any applicant wishing to be considered for employment beyond this time period should inquire as to whether or not applicants are being accepted at that time.

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 document or by conduct unless such change is specifically acknowledged in writing by an authorized executive of this organization.

In the event of employment, I understand that false or misleading information given in my application or interview(s) may result in discharge. I understand, also, that I am required to abide by all rules and regulations of the employer.

I acknowledge these terms