Employment Application

An Equal Opportunity Employer

We do not discriminate on the basis of race, color, religion, national origin, sex, age, disability, or any other status protected by law or regulation. It is our intention that all qualified applicants be given equal opportunity and that selection decisions be based on job-related factors.

Answer each question fully and accurately. No action can be taken on this application until you have answered all questions. In reading and answering the following questions, be aware that none of the questions are intended to imply illegal preferences or discrimination based upon non-job-related information.

Name*

Phone*

Address*

Email*

Which position are you applying for?

Are you seeking:

Full-Time

Part-Time

Available Start Date:

Are you 18 years of age or older?

Yes

If hired, can you furnish proof you are eligible to work in the U.S.?

Yes

Have you ever been convicted of any law violation? Include any plea of "guilty" or "no contest." Exclude minor traffic violations.

Yes

If yes, give details

If employed, do you expect to be engaged in any additional business or employment outside of our job?

Yes

If yes, give details

Do you have a valid driver's license?

Yes

Have you had your driver's license suspended or revoked in the last 3 years?

Yes

If yes, give details

List professional, trade, business or civic activities and offices held.

List Name and Address of Schools

High School or GED

Number of Years Completed

College or University

Number of Years Completed

Diploma/Degree/Certificate

Vocational or Technical

Number of Years Completed

Diploma/Degree/Certificate

What skills or additional training do you have that relate to the job for which you are applying?

What machines or equipment can you operate that relate to the job for which you are applying?

List names of employers in consecutive order with present or last employer listed first. Account for all periods of time including military service and any periods of unemployment. If self-employed, give firm name and supply business references. Note: A job offer may be contingent upon acceptable references from current and former employers.

Name of Employer

Job Title and Duties

Dates of Employment

Wage

Supervisor(s)

Phone

Reason For Leaving

Name of Employer

Job Title and Duties

Dates of Employment

Wage

Supervisor(s)

Phone

Reason For Leaving

Name of Employer

Job Title and Duties

Dates of Employment

Wage

Supervisor(s)

Phone

Reason For Leaving

Name of Employer

Job Title and Duties

Dates of Employment

Wage

Supervisor(s)

Phone

Reason For Leaving

Are you presently employed?

Yes

If yes, whom do you suggest we contact:

Give three references, not relatives or former employers.

Name

Address

Phone

Name

Address

Phone

Name

Address

Phone

Please Read Each Statement Carefully Before Submitting

I certify that all information provided in this employment application is true and complete. I understand that any false information or omission may disqualify me from further consideration for employment and may result in my dismissal if discovered at a later date.

I authorize the investigation of any or all statements contained in this application. I also authorize, whether listed or not, any person, school, current employer, past employers and organizations to provide relevant information and opinions that may be useful in making a hiring decision. I release such persons and organizations from any legal liability in making such statements.

I understand I may be required to successfully pass a drug screening examination. I hereby consent to a pre- and/or post-employment drug screen as a condition of employment, if required.

I understand that if I am extended an offer of employment it may be conditioned upon my successfully passing a complete pre-employment physical examination. I consent to the release of any or all medical information as may be deemed necessary to judge my capability to do the work for which I am applying.

I understand that this application, verbal statements by management, or subsequent employment does not create an express or implied contract of employment nor guarantee employment for any definite period of time. Only the owner of the company has the authority to enter into an agreement of employment for any specified period and such agreement must be in writing, signed by the owner and the employee. If employed, I understand that I have been hired at the will of the employer and my employment may be terminated at any time, with or without reason and with or without notice.

This application for employment will remain active for a limited time. Ask the organization's representative for details.

I have read, understand, and by submitting, consent to these statements.*

Employment Application

Company Information

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