APPLICATION FOR EMPLOYMENT

PERSONAL INFORMATION:

EMPLOYMENT DESIRED

EDUCATION

EMPLOYMENT HISTORY

Month & Year

Month & Year

Month & Year

REFERENCES:

GENERAL

PLEASE READ THE FOLLOWING STATEMENTS CAREFULLY BEFORE SIGNING THIS

APPLICATION. ONLY THOSE APPLICATIONS THAT ARE SIGNED AND DATED ARE

CONSIDERED VALID.

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, regardless of when discovered.

I understand that any employment is conditioned on a background check. I authorize the Company to thoroughly investigate all statements contained in my application or resume, and I authorize my former employers and references to disclose information 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, and former employers, and all references listed above from any and all 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. 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 cause and without prior notice, 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. 

I understand that if the Company hires me, I will be required to attest to my identity and employment eligibility and to present documents confirming my identity and employment eligibility. I understand that I cannot be hired if I cannot comply with these requirements.

If I am offered employment, I agree to submit to a medical examination and drug test 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 personnel 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 he 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 and procedures, in whole or part, at any time.