Employment Application

Qualified applicants receive equal consideration.  No question is asked for the purpose of excluding any applicant due to race, color, creed, national origin, religion, age, sex, handicap, veteran status, marital status, sexual orientation, or any other characteristic protected by law.  We are an equal opportunity employer.

The field descriptions in BOLD TEXT are required.

 
First Name: Last Name:
Address:
City: State:
Zip: Phone:
E-mail:
Desired Position: Click here to view job descriptions
If Other:
Desired Salary Range or Hourly Rate of Pay:
Referred by:
Attach your Resume (optional)
Note: The following file types are accepted: .doc, .docx, .wps, .txt, .rtf, .pdf, .xps
 

Employment History
Please list chronologically, beginning with most recent experience.
Employer: Address/City:
From (MM/YYYY): To (MM/YYYY):
Supervisor: Phone:
Salary:
Type of Work:
Reason for Leaving:
 
Employer: Address/City:
From (MM/YYYY): To (MM/YYYY):
Supervisor: Phone:
Salary:
Type of Work:
Reason for Leaving:
 
Employer: Address/City:
From (MM/YYYY): To (MM/YYYY):
Supervisor: Phone:
Salary:
Type of Work:
Reason for Leaving:
 

Education
Name & Location of School Select Last Year Completed Major Course Diploma/Degree
High School
College/University
College/University
Business or Trade School
 

Personal Information
Member of the Drug-Free Workplace Network. Pre-Employment Drug Testing is a Requirement.
Are you legally authorized to work in the U.S.?:
(If hired, you will be required to provide proof of work authorization.) 		Yes No
Are you at least 18 years of age?: Yes No
Have you ever been convicted of a crime (felony)?: Yes No
If yes, give details:
(Convictions are not automatic bar to employment)
Do you have any other skills you wish to mention?:
Are you presently employed?: Yes No
If so, may we contact your present employer?: Yes No
If hired, when would you be available?:
 

Employment References
List the name and telephone number of two business/work-related references who are not related to you.
1) Name of Reference: 2) Name of Reference:
Occupation: Occupation:
Address: Address:
City/State/Zip: City/State/Zip:
Phone: Phone:
Relationship: Relationship:
How long known: How long known:
 

Career Opportunities Disclaimer
I certify that all information I have provided in order to apply for and secure work with this employer is true, complete and correct.

I expressly authorize, without reservation, the employer, its representatives, employees or agents to contact and obtain information from all references (personal and professional), employers, public agencies, licensing authorities and education institutions and to otherwise verify the accuracy of all information provided by me in this application, resume or job interview. I hereby waive any and all rights and claims I may have regarding the employers, its agents, employees or representatives, for seeking, gathering and using truthful and non-defamatory information, in a lawful manner, in the employment process and all other persons, corporations or organizations for furnishing such information about me.

I understand that this employer does not unlawfully discriminate in employment and no question on this application is used for the purpose of limiting or eliminating any applicant from consideration for employment on any basis prohibited by applicable local, state or federal law.

I understand that this application remains current for only 30 days. At the conclusion of that time, if I have not heard from the employer and still wish to be considered for employment, it will be necessary for me to reapply and fill out a new application.

If I am hired, I understand that I am free to resign at any time, with or without cause and with or without prior notice, and the employer reserves the same right to terminate my employment at any time, with or without cause and with or without prior notice, except as may be required by law. This application does not constitute an agreement or contract for employment for any specified period or definite duration. I understand that no supervisor or representative of the employer is authorized to make any assurances to the contrary and that no implied oral or written agreements contrary to the foregoing express language are valid unless they are in writing and signed by the employer's president.

I also understand that if I am hired, I will be required to provide proof of identity and legal authorization to work in the United States and that federal immigration laws require me to complete and I-9 Form in this regard.

This Company does not tolerate unlawful discrimination in its employment practices. No question on this application is used for the purpose of limiting or excluding an applicant from consideration for employment on the basis of his or her sex, race, color, religion, national origin, citizenship, age, disability, or any other protected status under applicable federal, state, or local law. This Company likewise does not tolerate harassment based on sex, race, color, religion, national origin, citizenship, age, disability, or any other protected status. Examples of prohibited harassment include, but are not limited to, unwelcome physical contact, offensive gestures, unwelcome comments, jokes, epithets, threats, insults, name-calling, negative stereotyping, possession or display of derogatory pictures or other graphic materials, and any other words or conduct that demean, stigmatize, intimidate, or single out a person because of his/her membership in a protected category. Harassment of our employees is strictly prohibited, whether it is committed by a manager, coworker, subordinate, or non-employee (such as a vendor or customer). The Company takes all complaints of harassment seriously and all complaints will be investigated promptly and thoroughly.

I understand that any information provided by me that is found to be false, incomplete or misrepresented in any respect, will be sufficient cause to (i) eliminate me from further consideration for employment, or (ii) may result in my immediate discharge from the employer's service, whenever it is discovered.

DO NOT ELECTRONICALLY SIGN UNTIL YOU HAVE READ THE ABOVE APPLICATION STATEMENT

By checking this box I certify that I have read, fully understand and accept all terms of the foregoing Application Statement.