| Application
For Employment: We are an equal opportunity employer, dedicated to a policy of non-discrimination in employment on an basis including race, color, age, sex, religion, handicap or national origin. |
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| Personal Information | |||||||||||||||||||||||||||||||
| First Name: | |||||||||||||||||||||||||||||||
| Last Name | |||||||||||||||||||||||||||||||
| Social Security # | - - | ||||||||||||||||||||||||||||||
| Present Address | |||||||||||||||||||||||||||||||
| Permanent Address | |||||||||||||||||||||||||||||||
| Phone Number | - - | ||||||||||||||||||||||||||||||
| Referred By | |||||||||||||||||||||||||||||||
| 18 or Older | Yes I am 18 or older No I am not 18 yet | ||||||||||||||||||||||||||||||
| Have you ever been convicted of a felony? | Yes No If yes, please provide details. | ||||||||||||||||||||||||||||||
| Employment Desired | |||||||||||||||||||||||||||||||
| Position | |||||||||||||||||||||||||||||||
| Date You Can Start | |||||||||||||||||||||||||||||||
| Salary Desired | |||||||||||||||||||||||||||||||
| Are You Currently Employed? | Yes No | ||||||||||||||||||||||||||||||
| If So May Inquire Your Present Employer? | Yes No | ||||||||||||||||||||||||||||||
| Ever Applied to this Company Before? | Yes No If Yes: When? | ||||||||||||||||||||||||||||||
| Education | |||||||||||||||||||||||||||||||
| Grammar School | Name: Location: Did You Graduate: Yes No | ||||||||||||||||||||||||||||||
| High School | Name: Location: Did You Graduate: Yes No | ||||||||||||||||||||||||||||||
| College | Name: Location: Did You Graduate: Yes No | ||||||||||||||||||||||||||||||
| Trade Business or Correspondence School | Name: Location: Did You Graduate: Yes No | ||||||||||||||||||||||||||||||
| Subject Studied and Degrees Received | |||||||||||||||||||||||||||||||
| General | |||||||||||||||||||||||||||||||
| Subjects of Study or research Work | |||||||||||||||||||||||||||||||
| Job Related Skills | |||||||||||||||||||||||||||||||
| Activities Other Than Religious | |||||||||||||||||||||||||||||||
| Former Employers: List below your last four employers, starting with the last one first. | |||||||||||||||||||||||||||||||
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| References: List below three persons not related to you, whom you have known at least one year. | |||||||||||||||||||||||||||||||
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| If you are to be hired by the company, you will be required to attest to your identity and employment eligibility, and to present documents confirming your identity and employment authorization, including the federal government’s Employment Eligibility Verification Form (I-9). You cannot be hired if you cannot comply with these requirements. APPLICANT’S AUTHORIZATION AND CERTIFICATION I certify that the facts contained in this application (and accompanying resume, if any) are true and complete to the best of my knowledge. I understand that any false statement, omission, or misrepresentation on this application is grounds for refusal to hire, or dismissal if I have been employed, no matter when discovered by the Company. I understand that any employment is conditioned on a background check. I authorize the Company to thoroughly investigate all statements contained in my application or resume, and I authorize my former employers and references to disclose information regarding my former employment, character and general reputation to the Company, without giving me prior notice of such disclosure. In addition, I release the Company, and former employers and all references listed above from any and all claims, demands or liabilities arising out of or related to such investigation or disclosure. I understand and agree that nothing contained in this application, or conveyed during any interview, is intended to create an employment contract. I further understand and agree that if I am hired, my employment will be “at will” and without fixed term, and may be terminated at any time, with or without cause and without prior notice, at the option of either myself or the Company. No promises regarding employment have been made to me, and I understand that no such promise or guarantee is binding upon the Company unless made in writing. If I am offered employment, I understand that I may be obligated to submit to a medical examination and drug test before starting work. If employed, I also agree to submit to a medical examination or drug test at any time deemed appropriate by the Company and as permitted by law. I consent to such examination and tests, and I request that that the examining doctor disclose to the Company the results of the examination, which results shall remain confidential and segregated from my personnel file. I understand that my employment or continued employment, to the extent permitted by law, is contingent upon satisfactory medical examinations and drug tests, and if I am hired a condition of my employment will be that I abide by the Company’s Drug and Alcohol Policy. I understand that filling out this form does not indicate there is a position open and does not obligate the Company to hire me. If hired, I agree to abide by all Company work rules, policies and procedures. The Company retains the right to revise its policies or procedures, in whole or in part, at any time. |
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| By checking this box I affirm that I am the person listed on this application and that I agree with the statement above | |||||||||||||||||||||||||||||||
| Applicant's initials: | |||||||||||||||||||||||||||||||