Fillable Printable Sysco Application Form
Fillable Printable Sysco Application Form
Sysco Application Form
Revised July 2007
1
NOTICE TO APPLICANTS FOR EMPLOYMENT
AT SYSCO FOOD SERVICES OF IDAHO
SYSCO Food Services of Idaho is an “at will” employer, which means that either the employer or
the employee may terminate the employment relationship at any time for any or no reason, with or
without notice.
I understand that I will be permitted to submit an application for one position only per application
as designated by me on each application form. I further understand that inclusion of more than
one position on the application form will disqualify my application from further processing.
The application process consists of completing the following:
1. Application Form
2. Affirmative Action Voluntary Information Statement
3. Drug & Alcohol Screen Form
4. Supplemental Driver Application Form (For Driver Position Applicants Only
)
5. Policy/Acknowledgement Regarding Post-Offer, Pre-Placement Testing
6. Operations, Transportation, or Sales Questionnaire
This company will make reasonable accommodation in the application process, if needed.
I understand that this application and any attachments are the property of SYSCO Food Services
of Idaho. I further understand that it is my responsibility to complete the application process and
send the forms to SYSCO Food Services of Idaho’s office, as well as complete the applicable
Questionnaire for the position I am applying for.
I have read and understand this notice of the application process at SYSCO Food Services of
Idaho.
Signature ____________________________________ Date _______________________
Revised July 2007
2
SYSCO FOOD SERVICES OF IDAHO
EMPLOYMENT APPLICATION
Post Office Box 170007
Boise, Idaho 83717
Equal Opportunity/Affirmative Action Employer
Please complete the form entirely. Incomplete applications will not be considered as legitimate employment inquiries.
Driver applicants must also complete the Supplemental Driver Application form.
Date of application __________________ Position applying for ____________________________________________
________________________________________________________________________________________________
Last Name First Middle Telephone Number
________________________________________________________________________________________________
Street Address City State Zip Code
General Data:
Are you eligible for work in the U.S.? Yes ___ No___ Are you 18 years of age or older? Yes____ No____
Have you reviewed the job description for the position to which you are applying? Yes ____ No ____
If so, can you perform the essential job functions with or without reasonable accommodation? Yes ____ No ____
Date available for work:_____________ Salary requirements:________________________________
Are you willing to work weekends? Yes___ No___ Are you willing to work nights? Yes____ No____
Available for Full-Time ___ or Part-Time ___ If Part-Time, specify hours and days:___________________________
Have you ever been employed by any SYSCO Co.? Yes___ No___ If so, where and when______________________
How/Where did you learn of this vacancy at SYSCO?: __________________________________________________
Have you ever been convicted, entered a plea of nolo contendre or received a withheld judgment for any criminal offense?
(A conviction will not necessary disqualify an applicant)?
Yes___ No___ If yes, explain:______________________________________________________________________
Summarize special job-related skills, qualities, or other experience acquired that may qualify you for this position:
______________________________________________________________________________________________
______________________________________________________________________________________________
Education:
School name & City, State Course of Study Years/Credits Completed G.P.A. Diploma/Degree
Do you have business or professional certificates or licenses? Yes___ No___ If yes, type_______________________
State issued______________ Certificate No._______________ Year Issued_________ Expiration Date____________
Revised July 2007
3
SYSCO FOOD SERVICES OF IDAHO
EMPLOYMENT APPLICATION
Employment:
Start with your present or most recent position and work back to cover the last ten (10) years. List and account for
any periods of unemployment longer than six months. If you were employed in any position under a different
name, include that name. You must complete this information even if resume is attached. If you need additional
space, please attach the Additional Employment Information Sheet.
May we contact your present employer? Yes___ No___
Company Name:___________________________________ Dates Employed, from___________ to ___________
Address:_________________________________________________________ Telephone No._______________
Type of Business:______________________ Job Title:__________________ Supervisor:____________________
Salary Start:____________ End:____________ Reason for Leaving:_____________________________________
Duties:______________________________________________________________________________________
Company Name:___________________________________ Dates Employed, from___________ to ___________
Address:_________________________________________________________ Telephone No._______________
Type of Business:______________________ Job Title:__________________ Supervisor:____________________
Salary Start:____________ End:____________ Reason for Leaving:_____________________________________
Duties:______________________________________________________________________________________
Company Name:___________________________________ Dates Employed, from___________ to ___________
Address:_________________________________________________________ Telephone No._______________
Type of Business:______________________ Job Title:__________________ Supervisor:____________________
Salary Start:____________ End:____________ Reason for Leaving:_____________________________________
Duties:______________________________________________________________________________________
Company Name:___________________________________ Dates Employed, from___________ to ___________
Address:_________________________________________________________ Telephone No._______________
Type of Business:______________________ Job Title:__________________ Supervisor:____________________
Salary Start:____________ End:____________ Reason for Leaving:_____________________________________
Duties:______________________________________________________________________________________
Revised July 2007
4
SYSCO FOOD SERVICES OF IDAHO
ADDITIONAL EMPLOYMENT INFO SHEET
(Over and above what is listed on the application
and only if needed)
Company Name: ____________________________ Dates employed From: _____________ To: _____________
Address: _______________________________________________________ Phone #: _____________________
Type of business: ________________________________ Job title: _____________________
Supervisor: _________________ Salary start: ________________ End salary: ________________
Reason for Leaving: ___________________________________________________________________________
Duties: ______________________________________________________________________________________
Company Name: ____________________________ Dates employed From: _____________ To: _____________
Address: _______________________________________________________ Phone #: _____________________
Type of business: _______________________________ Job title: _____________________
Supervisor: _________________ Salary start: ________________ End salary: ________________
Reason for Leaving: ___________________________________________________________________________
Duties: ______________________________________________________________________________________
Company Name: ____________________________ Dates employed From: _____________ To: _____________
Address: _______________________________________________________ Phone #: _____________________
Type of business: ________________________________ Job title: _____________________
Supervisor: _________________ Salary start: ________________ End salary: ________________
Reason for Leaving: ___________________________________________________________________________
Duties: ______________________________________________________________________________________
Revised July 2007
5
SYSCO FOOD SERVICES OF IDAHO
EMPLOYMENT APPLICATION
PLEASE READ AND SIGN BELOW FOR ACKNOWLEDGMENT:
1. I certify that the statements made by me in this application are true, complete, and correct to the best of my
knowledge and belief and have been made in good faith.
2. I hereby grant the Company permission to verify the information provided herein. I further understand that
any false statement or omission on this application may result in rejection of this application, or for
dismissal if such false statement or omission is discovered at any time after I have been hired.
3. This Employment Application is used to notify me that the nature and scope of an investigation, if one is
conducted, could include such general identification information as residence verification, and, as
applicable, information concerning my employment, education, general reputation, character, personal
characteristics, and habits, and that such information may be developed through personal interviews with
third parties such as family members, neighbors, friends, associates, former employers, and custodians of
official records. Only job-related information developed from such a report will be considered in
evaluating my employment application or continued employment. I hereby authorize these persons,
companies, organizations or corporations to answer all questions or release any information regarding the
items listed in this paragraph. I hereby release them from any liability and hold them harmless from any
claim for releasing any truthful information within their knowledge and/or records.
4. I understand that any job offer that may be extended to me will be contingent upon the successful
completion of a drug and alcohol test, and, for positions in Sales, Operations or Management, a physical
fitness for duty test.
5. I understand that neither this application nor any written personnel procedure manual or employee
handbook is an express or implied contract of permanent employment. I further understand that my
relationship with the Company is “at-will,” for an unspecified term, and that the Company and I each have
the right to terminate the employment relationship at any time, with or without cause or advance notice.
6. I understand that no representative of the Company, other than the President, has the authority to enter into
any agreement for employment for any specified period of time, or assure or make some other personnel
agreement, either prior to commencement of employment or after I have become employed, or to assure
any benefits or terms and conditions of employment, or make any agreement contrary to foregoing. I
further understand that any such agreement must be in writing and signed by the Company President.
7. It is the policy of the Company to implement affirmatively equal opportunity to all qualified employees and
applicants for employment without regard to race, color, religion, age, current or future veteran status,
national origin, disability, gender, or ethnic group and appropriate action will be taken to ensure the
fulfillment of this policy.
8. I understand that any offer of employment is dependent upon my ability to present verification of my legal
right to work in the United States.
9. I certify that I am not listed as debarred, suspended, or otherwise ineligible for Federal programs as set
forth in the list of Parties Excluded from Federal Procurement Programs publication.
“I have had an opportunity to have my questions about this statement’s content and intent answered and
understand its terms.”
_____________________________________________ ______________________
Signature of Applicant Date
Revised July 2007
6
SYSCO FOOD SERVICES OF IDAHO
AFFIRMATIVE ACTION VOLUNTARY INFORMATION
Federal regulations require the Company to provide you an opportunity to self identify for affirmative action. Providing this information
is entirely optional and voluntary; disclosure or refusal to complete this form will not subject you to any adverse treatment. You may
self identify or request to benefit under the Company’s Affirmative Action Program now or at any time in the future. The information
will be kept confidential, separate from hiring decisions and personnel records, and will be used only in accordance with the above
regulations.
PLEASE CHECK EACH BOX THAT APPLIES TO YOU:
Gender: Female Male
Race/Ethnic Group: Black or African American (Not of Hispanic or Latino origin) – All persons having origins in any of
the black racial groups of Africa.
Asian (Not of Hispanic or Latino origin)– All persons having origins in any of the original peoples of
the Far East, Southeast Asia, or Indian Subcontinent, including for example, Cambodia, China, India,
Japan, Korea, Malaysia, Pakistan, the Philippine Islands, Thailand, and Vietnam.
Native Hawaiian or Other Pacific Islander (Not of Hispanic or Latino origin) – All persons having
origins in any of the original peoples of Hawaii, Guam, Samoa, or other Pacific Islands.
American Indian or Alaskan Native (Not of Hispanic or Latino origin) – All persons having origins in
any of the original peoples of North and South America (including Central America), and who
maintain cultural identification through tribal affiliation or community attachment.
Hispanic or Latino – All persons of Mexican, Puerto Rican, Cuban, Central or South American, or
other Spanish culture or origin, regardless of race.
White (Not of Hispanic or Latino origin) – All persons having origins in any of the original peoples of
Europe, North Africa, or the Middle East.
Two or More Races (Not of Hispanic or Latino origin) – All persons who identify with more than one
of the above five races.
PLEASE CHECK THE BOX BELOW IF IT APPLIES TO YOU:
Vietnam Era Veteran An eligible veteran (at least 180 days active duty), any part of whose active military service was in
Vietnam between 02/28/61 and 05/07/75 or elsewhere between 08/05/64 and 05/07/74.
Other Eligible Veteran Other Eligible Veteran – Active duty (at least 180 days) service member receiving campaign or
expeditionary badge.
Please sign below to acknowledge that you had an opportunity to self identify.
Applicant’s Printed Name
Applicant’s Signature Date
Referral Source: (job service, advertisement, employee name, etc.)
This company’s affirmative action programs may be reviewed by any employee or applicant in the Human Resources Department,
Monday through Friday, from 9:00a.m. until 4:00p.m.
Revised July 2007
7
SYSCO FOOD SERVICES OF IDAHO
DRUG & ALCOHOL SCREEN FORM
I voluntarily agree to a urine, breath and/or blood test for drug and alcohol testing. I agree to provide urine, breath
and/or blood specimens and authorize SYSCO Food Services of Idaho (“the Company”) to use such specimens for
the purpose of complying with the provisions of its Drug and Alcohol Policy. I further authorize those persons or
firms taking such sample specimens to release the results of any drug or alcohol test to the Company.
I agree that such results may be used in the refusal to hire me or as the basis for disciplinary action up to and
including termination. I understand that the Company will maintain the confidentiality of the test results.
Our policy prohibits the use of any legally obtained drug (prescriptions or over-the-counter medications) when
such use adversely affects job performance or safety, or any combination thereof. Applicants who are taking
prescription drugs or over-the-counter drugs that may affect their performance should discuss their situation with
the HR Department and obtain permission before beginning work. Applicants shall not disclose their underlying
diagnosis or the name of the medication they are taking; however, they may be required to provide properly written
medical authorization from a physician to work while using such authorized medications. The Company’s
designated Medical Review Officer is solely authorized to determine the result of drug & alcohol tests.
This consent will remain in effect for the entire term of my employment with the Company.
I also understand that if I refuse the testing, which is my right, any employment consideration will be terminated
immediately.
I hold harmless the Company, its officers and its employees for any authorized implementation of this policy.
__________________________________ _________________________________
Applicant Name (Please Print) Witness Name (Please Print)
__________________________________ __________________________________
Applicant Signature Witness Signature
__________________________________ _________________________________
Date Date
Revised July 2007
8
AGREEMENT, AUTHORIZATION, AND CONSENT FOR RELEASE OF BACKGROUND
INFORMATION
PLEASE TYPE OR PRINT
I, __________________________________________________________________________________________,
LAST NAME FIRST NAME MIDDLE NAME (PLEASE INCLUDE Jr., Sr., II, III Etc.)
understand that in conjunction with my application for employment, work to be performed under contract, promotion,
reassignment, and/or retention("Employment") Sysco Food Services of Idaho will use the services of an outside agency to
research and verify the information I have provided on my application for employment including my personal background,
character, professional standing, work history and qualifications. This agency will provide a written report of its findings to
Sysco Food Services of Idaho. Sysco Food Services of Idaho uses a contract consumer-reporting agency, as an agent to
perform its Employment related background investigations.
Our contract agency will utilize various sources of information it deems appropriate including but not limited to: credit
reporting agencies, department of motor vehicle records, criminal conviction records, current and former employers,
education records, professional and personal references. I agree, authorize and consent to the release and disclosure of any
and all information including but not limited to the above to Sysco Food Services of Idaho and our contract agency.
I agree, authorize and consent to the procurement of a Consumer Report and/or an Investigative Consumer Report and
understand that it may contain information about my creditworthiness, credit standing, credit capacity, character, general
reputation, personal characteristics, or mode of living. This authorization in original or copy form shall be valid for my term of
Employment from the date indicated next to my signature. According to the Fair Credit Reporting Act, I will be notified by
Sysco Food Services of Idaho if Employment is denied because of information obtained from a Consumer Reporting Agency.
Additionally, I understand that if requested within 60 days, I will be given a full and accurate disclosure as to the nature and
substance of all information provided to Sysco Food Services of Idaho. I further understand that I may request a copy of the
report, and that when doing so, proper identification will be required and I should direct my request to: Sysco Food Services
of Idaho, 3000 Lava Ridge Ct, Roseville, CA 95661. I understand that residents of all states will automatically receive a copy
of the report if an adverse action is taken regarding the employment application, or upon request as outlined Herein.
LAW ENFORCEMENT AGENCIES AND OTHER ENTITIES FOR POSITIVE IDENTIFICATION PURPOSES REQUIRE THE
FOLLOWINGINFORMATION WHEN CHECKING PUBLIC RECORDS. IT IS CONFIDENTIAL AND WILL NOT BE USED
FOR ANY OTHER PURPOSES.PLEASE PRINT CLEARLY.
________________________________________________________ _________________________________
Signed Today's Date
________________________________________________________ _________________________________
Name as it appears on your driver's license Position Applied For
_____________________________ ________________________ _________________________________
Social Security Number Date of Birth Driver's License Number State
___________________________________________________________________________________________
Other names you have used or are also known as, including maiden name, name changes and any aliases
PLEASE PROVIDE ALL RESIDENTIAL ADDRESSES FOR THE PAST 7 YEARS
Mo./Yr. / Mo./Yr.
Current Address: ________________________________________________________________________
Street Apt.# City State Zip Code From
Former Address: _________________________________________________________________/______
Street Apt.# City State Zip Code From / To
Former Address: _________________________________________________________________/______
Street Apt.# City State Zip Code From / To
Former Address: _________________________________________________________________/______
Street Apt.# City State Zip Code From / To
Revised July 2007
9
Date of Birth:_____________________
SYSCO FOOD SERVICES OF IDAHO
SUPPLEMENTAL INFORMATION FOR DRIVER APPLICANTS ONLY
Name:___________________________ Position:__________________ City:___________________
EXPERIENCE AND QUALIFICATIONS
DRIVER LICENSES AND ENDORSEMENTS
State Issued License Number Type Expiration Date
Have you ever been denied a license, permit, or privilege to operate a motor vehicle? Yes___ No___
Has any license, permit, or privilege ever been suspended or revoked? Yes___ No___
Class of Equipment Type of
(Van, Tank)
Date:
From
Date:
To
Approx. # of
Miles Driven
Straight Truck
Tractor /Trailer
Tractor/Doubles
Other
Drug Test Record for the past 3 years
Have you ever tested positive for illegal drugs or alcohol on any test conducted in the past 3 years?
____ Yes ____ No If yes, details: ____________________________________________________________
Have you ever refused to take a test for illegal drugs or alcohol? ____ Yes ____ No If yes, when? _________
Accident Record for the past 3 years or more (attach sheet if more space is needed.)
Dates
Nature of Accident & est. $ Amount
(Head On, Rear End, Upset, Etc.)
Fatalities
Injuries
Traffic convictions and forfeitures for the past 3 years (other than parking violations)
Location Date Charges Penalty
(Attach sheet if more space is needed.)
Warehouse Experience
List types of platform experience and years of each__________________________________________
List platform equipment you can operate (lift truck, etc.)______________________________________
List courses or training in platform work______________________________________________________
Other Experience and Qualifications
List any trucking, transportation or other experience that may help in your work for this company.
__________________________________________________________________________________________
__________________________________________________________________________________________
Revised July 2007
10
SYSCO FOOD SERVICES OF IDAHO
POLICY REGARDING POST-OFFER, PRE-PLACEMENT TESTS
Post offer/Pre-placement/Post Employment examinations are successful tools utilized to create a safer working
environment for employees. With the advent of sports technology applied to the industrial worker, comprehensive
stress tests monitor heart and musculoskeletal function to detect disease processes, wear and tear syndromes, and
many other problems that lead to injuries and disability. Computerized testing and stress evaluations by licensed
professionals in a medical setting typically cost over one thousand dollars, SYSCO Food Services of Idaho is
willing to pay for such services to help their employees remain safe in the workplace and to reduce costs associated
with injuries. Training provided during the examinations increases body awareness during work activities to
prevent cumulative trauma and to successfully reduce injuries. Furthermore, employee turnover and operating
expenses are reduced, by maintaining properly qualified personnel in each position.
As a result, SYSCO Food Services of Idaho is implementing the WorkSTEPS
evaluation program for prospective
candidates and existing employees. This program has been in effect since 1986, has one of the largest normative
data bases that every job and every employee are different, the tests are utilized to determine whether or not the
individual can safely perform job duties.
When necessary to enable an otherwise qualified candidate with a “disability” to participate in testing, the
Company will provide reasonable accommodations, provided such accommodations do not cause an undue
hardship. Candidates, who believe they need an accommodation to participate in the testing program, must request
such accommodations in writing. To minimize or avoid delays in testing, the Company asks candidates to advise
the Company of the need for any accommodation as soon as possible after you have received a conditional offer of
employment.
Policy:
All persons interested in being considered for the positions of Loader, Selector, Driver or Marketing Sales
Associate (or Trainee) will be required to successfully complete a functional employment test. The following is
the process that will be followed.
1. Candidates should report to SYSCO to complete the necessary application forms and questionnaire.
2. Authorized staff members will interview candidates.
3. An authorized staff member will offer employment to those candidates deemed to be the best overall fit for
the positions sought. The offer of employment will be contingent upon the successful completion of a post-
offer drug screen and functional employment test.
4. Upon receiving a conditional offer of employment, candidates will be a given a written job description and
additional written information regarding the post-offer/pre-placement test. After carefully reviewing this
information and/or consulting with their personal physicians, each candidate must complete a release
authorizing the Company and WorkSTEPS to conduct the post-offer functional employment tests.
Requests for accommodations should be noted on the release. Depending on the nature of the
accommodation sought, further discussions and/or medical documentation may be needed to identify an
appropriate accommodation. Testing will be delayed until the interactive process aimed at identifying
appropriate and necessary reasonable accommodations is completed.
5. Once the Company receives a fully completed release and any requests for reasonable accommodation are
resolved, the Company will schedule the candidate for the post-offer/pre-placement test.
Revised July 2007
11
SYSCO FOOD SERVICES OF IDAHO
POLICY REGARDING POST-OFFER, PRE-PLACEMENT TESTS
Continued
6. Upon reporting to the licensed WORKSTEPS testing facility, the candidate will be examined by a licensed
occupational or physical therapist and their staff.
7. An authorized representative will inform a candidate, who successfully completes the post-offer/pre-
placement test, of a “start” date.
8. The Company will notify any candidate who fails to successfully complete the post-offer/pre-placement
test. Because the Company seeks to make employment decisions based on the best available objective
medical evidence, any candidate who fails the test should provide the Company with any additional
information they believe the Company should consider before withdrawing its conditional offer of
employment.
9. Absent receipt of additional information that persuades the Company that a candidate can perform the
essential functions of the position sought with or without reasonable accommodation, the Company will not
hire candidates who fail to successfully complete the post-offer/pre-placement test.
Additional Points:
The cost of the post-offer/pre-placement/post employment test procedures are paid by the company. Medical
information collected in connection with such tests will be maintained in confidential files in accordance with
requirements of the Americans with Disabilities Act (ADA) and the information collected will not be used for any
purpose inconsistent with the ADA.
The Company is an equal opportunity employer and does not discriminate against individuals on the basis of race,
color, religion, gender, national origin, military status, disability, or any other basis protected by federal, state or
local law.
Nothing in this policy is intended to be, and should not be construed as, a contract for any particular term or
condition of employment. Individuals are employed “at will”, which means that the Company or the
applicant/employee can terminate the employment relationship at any time, with or without cause or notice.
Acknowledgment:
I have read the above policy and understand that if offered employment it will be conditioned on the successful
completion of a post-offer/pre-placement functional employment examination. I hereby agree to comply with the
above procedure and request that my application for employment be processed pursuant to this policy.
________________________________ ________________________________
Signature of Applicant/Date Company Representative/Date
________________________________ ________________________________
Application Name (Please Print) Representative Name (Please Print)
