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Application For Employment

Please Fill in all the required fields.
* Required Fields
Personal Details
First Name : *
Middle Name : *
Last Name : *
Phone Number : *
Email Address : *
Are You Over 18? :
Present Address
Street Line 1 : *
Street Line 2 :
City : *
State : *
Zip Code :
Permanent Address
Street Line 1 : *
Street Line 2 :
City : *
State : *
Zip Code :
What Do You Expect From Us?
Referred By :
Position Desired : *
Date You Can Start : *
Salary Desired : *
Are You Employed Now :
If so, may we inquire of your present employer? :
Ever applied to this company before? :
Where :
When :
Educational Details
Grammar School Name :
Grammar School location :
High School Name :
High School location :
How many years of high school did you complete? :
Did you graduate from high school or hold a GED? :
Trade, business or correspondence school :
College Name :
College location :
Subjects Studied :
Degree(s) received :
General Details
Subjects of special studies or research work :
Job related skills or experience :
Activities other than religious (Civic, athletic, etc.) Exclude organizations the name or character of which indicates the race, gender, color or national origin of its members. :
Former Employers #1 Details
Company Name :
Address 1 :
Address 2 :
City :
State :
Zip Code :
Start Date :
End Date :
Position :
Salary upon leaving :
Reason for leaving :
Former Employers #2 Details
Company Name :
Address 1 :
Address 2 :
City :
State :
Zip Code :
Start Date :
End Date :
Position :
Salary upon leaving :
Reason for leaving :
Former Employers #3 Details
Company Name :
Address 1 :
Address 2 :
City :
State :
Zip Code :
Start Date :
End Date :
Position :
Salary upon leaving :
Reason for leaving :
Former Employers #4 Details
Company Name :
Address 1 :
Address 2 :
City :
State :
Zip Code :
Start Date :
End Date :
Position :
Salary upon leaving :
Reason for leaving :
References #1 Details
Name :
Address 1 :
Address 2 :
City :
State :
Zip Code :
Phone number :
Position :
Years aquainted :
References #2 Details
Name :
Address 1 :
Address 2 :
City :
State :
Zip Code :
Phone number :
Position :
Years aquainted :
References #3 Details
Name :
Address 1 :
Address 2 :
City :
State :
Zip Code :
Phone number :
Position :
Years aquainted :
AUTHORIZATION

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 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 authorized the Company to thoroughly investigate all statements contained in my application or resume, and I authorize my former employer employers and references to disclose any and all information in any personnel file, whether official or unofficial, 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, any former employers and all references listed above from any and all claims, demands or liabilities arising out of or related to such disclosure.

 

I understand that in order to work with the Company that I must be authorized to work in the United States.

 

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 prior notice and with or without cause, 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 and signed by the Company president and myself.

 

If I am offered employment, I agree to submit to a medical examination and drug test if required 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 examinations and tests, and I request that the examining doctor disclose to the Company the results of the examination, which results shall remain confidential and segregated from my personal file. I understand that my employment or continued employment, to the extent permitted by law, is contingent upon satisfactory medical examinations and drug test, 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. 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 without prior notice, in which or in part, at any time.

I certify that the information provided is true, correct, and complete.
   
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