APPLICATION FOR EMPLOYMENT

Name of Employer *

Address *

City *

State *

Zip *

Phone number *

Reason for leaving (be specific) *

List the jobs you held, duties performed, skills used or learned, advancements or promotions while you worked at this company. *

Name of Employer

Address

City

State

Zip

Phone number

Reason for leaving (be specific)

List the jobs you held, duties performed, skills used or learned, advancements or promotions while you worked at this company.

Name of Employer

Address

City

State

Zip

Phone number

Reason for leaving (be specific)

List the jobs you held, duties performed, skills used or learned, advancements or promotions while you worked at this company.

Are you currently employed? *

May we contact your present employer? *

Did you complete this application yourself *

If not, who did? *

Have you ever been in the armed forces? *

Are you now a member of the National Guard? *

If hired, can you provide proof of U.S. citizenship *

or proof of your legal right to live and work in this country? *

Have you ever been employed with this company? *

Do you have any friends or relatives employed by this company? *

If hired, would you have a reliable means of transportation to and from work? *

Are you able to perform the essential functions and duties of the job for which you are applying? *

REFERENCES

Please list below three persons not related to you who have knowledge of your work performance and/or personal qualifications within the last 5 years.

Name *

Occupation *

Company name *

Address *

Telephone *

E-mail *

Years acquainted *

Name *

Occupation *

Company name *

Address *

Telephone *

E-mail *

Years acquainted *

Name

Occupation

Company name

Address

Telephone

E-mail

Years acquainted

APPLICATION FORM WAIVER

Please read each paragraph closely, initial each, and sign below

I hereby certify that I have not knowingly withheld any information that might adversely affect my chances for employment and that the answers given by me are true and correct to the best of my knowledge. I further certify that I, the undersigned applicant, have personally completed this application. I understand that any omission or misstatement of material fact on this application or any other document used to secure employment shall be grounds for rejection of this application or for immediate discharge if I am employed, regardless of the time elapsed before discovery.

I hereby authorize thorough investigation of my references, work records, education, driving record, credit history, criminal background and other matters related to my suitability for employment. I further authorize the employers, schools and other references I have listed to disclose any and all documents, transcripts, letters, reports and other information related to these references, without giving me prior notice of such disclosure. I hereby release this potential employer, my former employers, and all other persons, corporations, partnerships and associations from any and all claims, demands or liabilities arising out of or in any way related to such investigation or disclosures.

I understand that nothing contained in the application, or conveyed during any interview which may be granted, or during my employment, if hired, is intended to create an employment contract between me and the Company, other than one that is “at will.” I understand and agree that if I am employed, my employment will be of an “at will” nature, whereby either the employee or the employer may terminate the employment relationship at any time, with or without cause or notice. I further understand that my employment, if hired, is for no definite or determinable period of time and may be terminated at any time, at the option of either myself or the Company, and that no promise or representation contrary to the foregoing is binding on the company unless made in writing and signed by me and the company’s designated representative.

I understand that I may be requested to submit to drug testing. Each employee, as a condition of employment, may be required to participate in pre-employment, random, reasonable suspicion and follow-up testing upon selection or request of management. All drug-testing information will be maintained in separate confidential records.

I understand that 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 applications are being accepted at this time.

The employer is an equal employment opportunity employer dedicated to a policy of nondiscrimination in employment upon any basis, including race, creed, color, national origin, sex, affectional or sexual orientation, age, marital status, religion, or disability. We assure you that your opportunity for  employment with our company depends solely on your qualifications.