Ben’s considers all applicants for employment without regard to race, religion, color, sex, gender, sexual orientation, pregnancy, age, handicap or disability, national origin, military/veteran status or special disabled veteran, or any other protected classification, in accordance with applicable federal, state or local laws. In addition, Ben’s complies with applicable state and local laws prohibiting discrimination in employment in every jurisdiction in which it maintains facilities. Ben’s also provides “reasonable accommodations” to qualified individuals with disabilities, in accordance with the American Disabilities Act and applicable state and local laws.

    Applicant Information

    Are you over the age of 18?*

    If you are under 18, hire is subject to verification that you are of minimum legal age.

    Have you ever been employed by us?*

    Is there anything that would prevent you from performing in a reasonable and safe manner the activities involved in the position for which you have applied?*

    Are you authorized to work for all employers in the United States on a full-time basis, or only for your current employer?**

    **Federal Law requires that employers hire only individuals who are authorized to be lawfully employed in the United States. In compliance with such laws, all offers of employment are subject to verification of the applicants identity and employment authorization, and it will be necessary for you to submit documents as are required by law to verify your identification and employment authorization upon employment.



    Do you want to work:*

    Are you willing to work overtime as necessary?*

    Please tell us the days and hours you can work:


    Relatives employed by Ben’s

    Please let us know if you have any relatives employed by Ben’s. If you don’t have any relatives working for Ben’s, please skip to the next section.


    Education History

    Did you graduate?

    Did you graduate?

    Did you graduate?

    Did you graduate?


    Employment History

    List in order (last or current employer first). Account for any gaps in your employment.

    Add another job


    Military Service Record

    Have you ever served in the U.S. Armed Forces?*


    Additional Skills

    Would you be willing to drive if required for the job?*

    Do you have a clean, valid N.Y.S driver’s license?*


    Personal References (Excluding Relatives)

    Please provide at least three references.




    Preemployment Statement

    (Please read carefully and sign the statement below)