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Employment Application Form

Fields marked with an * are required

It is our policy to provide equal employment opportunities and will not unlawfully consider any factors of race, religion, age, creed, national origin, gender, disability, sexual orientation, veteran status, genetic information or any and all other unlawful biases regarding federal, state or local laws with regard to workers or applicants.

TO BE CONSIDERED FOR EMPLOYMENT, ALL APPLICANTS MUST FILL OUT THIS FORM COMPLETELY. THIS APPLICATION WILL BE GIVEN EVERY CONSIDERATION, BUT ITS RECEIPT DOES NOT IMPLY THAT THE APPLICANT WILL BE EMPLOYED BY OUR COMPANY. THIS FORM BECOMES A PART OF YOUR EMPLOYMENT RECORD IF YOU ARE HIRED. THIS APPLICATION IS ONLY VALID FOR 30 DAYS.


Personal Information

If you have lived at the above address for less than 12 months, please list previous address:


Work Interest


Work History

List the names of employers in consecutive order with present or last employer listed first. Account for all periods, including military service. If self-employed, give firm name and supply additional references.
PLEASE GIVE BOTH MONTH AND YEAR.


Education – High School

Education – College or University


If you went to college, but did not graduate, how many credit hours are needed for your degree?

Education – Graduate School

Education – Trade or Technical School


Certifications / Licenses

Please list any certifications or licenses you have:


References


Special Skills – Computer


Employment Application – Affidavit

Additional Terms & Conditions of Employment


Please read these paragraphs and enter your initials below each of them to indicate you have read and agree to them:


I certify that the answers given by me to the foregoing questions and statements on the employment application and/or during the employment interview process are true and correct without any consequential omissions of any kind whatsoever.  I understand that any misleading or incorrect statements may render this application void and, if employed, would be cause for my termination.  I further agree that the Company shall not be liable in any respect if my employment is terminated because of falsity of statements, answers or omissions made by me in this application.


I understand that this application is designed for use with several types of jobs and some questions may not be completely applicable to the position for which I am applying.


I authorize the companies, schools, persons or entities given during the employment process, and the employer (if employed), while employed, or during internal investigations, as references or past employers or affiliations, to give any information regarding my employment, character, qualifications, certifications and licenses, and hereby release said companies, schools, persons or entities from all liability for any damage for issuing this information. A favorable result may be a condition of employment, commencement, or continuation of any employment duties where elements are job-related.


I understand that I may be required to have a medical examination and/or drug and alcohol test after an offer of employment has been made and prior to the commencement of my employment duties.  A favorable result on the medical examination and/or drug and alcohol test would be a condition of my employment or commencement of any employment duties as well as any time throughout my employment according to company policy.


I realize that operating conditions may require me to work shifts or work hours scheduled other than the one for which I am applying and I agree to such scheduling change as directed by my supervisor or the management.


I understand that my employment is not for a specified or definite term and that I may resign, or I may be discharged, at any time, for any reason, with or without good cause and with or without prior notice.  I further understand that this policy cannot be changed or amended except by written agreement signed by me and by a corporate officer.  I understand that this is an application for employment and that no employment contract is being offered.


I understand that only United States citizens or aliens who are legally entitled to work in the United States are eligible for employment.


My employment shall be in accordance with the terms of this application, all safety and incident reporting rules, and all other Company rules and regulations.  The Company shall have the right to amend, modify, or revoke its rules and regulations at any time.  I will familiarize myself promptly with such rules and regulations and will abide and be bound by the rules and regulations now or hereafter in effect.


I certify that as a part of the application process, I have read the job description and have had the opportunity to review the requirements for the position for which I have applied. I certify that I understand each requirement and that I am capable of meeting each and every requirement.


I certify that facts contained in this application (and 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 sufficient cause 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 investigate all written and oral statements I make, and authorize my former employers and references to disclose information regarding my former employment, character and general reputation to the Company, without giving me prior noticed of such disclose. I release the Company, any former employers and all references listed above from any 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. If I am hired, my employment will be “at will” and without fixed term. 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 hired, I agree to submit to a medical examination and drug test before starting work. If employed, I agree to submit to a medical examination or drug test at any time deemed by the Company and as permitted by law. I consent to such examinations and tests, and I request that the examining doctor disclose to the Company the results of the examination, which results shall remain confidential. A condition of employment will be that I abide by all Company policies. I understand that filling out this form does not indicate there is a position open and does not obligate the Company to hire. 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.