Application for Employment

Application for Employment

Please answer all questions. Resumes are not a substitiute for a completed application. We are an equal opportunity employer. Applicants are considered for positions without regard to veteran status, uniformed servicemember status, race, color, religion, sex national origin, age, physical or mental disability, genetic information or any other category protected by applicable federal, state or local laws. This application for employment is not an employment contract. THIS COMPANY IS AN AT-WILL EMPLOYER AS ALLOWED BY APPLICABLE STATE LAW. THIS MEANS THAT REGARDLESS OF ANY PROVISION IN THIS APPLICATION, IF HIRED, THE COMPANY OR I MAY TERMINATE THE EMPLOYMENT RELATIONSHIP AT ANY TIME, FOR ANY REASON, WITH OR WITHOUT CAUSE OR NOTICE.

* Indicates a required field.
Name
Name
First
Last
Permanent Address
Permanent Address
City
State/Province
Zip/Postal
Country
Alternate Address
Alternate Address
City
State/Province
Zip/Postal
Country
If under the age of 16, can you produce the necessary work certificate at the time of employment?
If hired, can you provide proof that you are legally eligible for employment in the U.S.?
(Pursuant to the Immigration Reform and Control Act of 1986, all applicants (U.S. and non-U.S.) who are offered employment must produce documents establishing their identity and authorization for U.S. work no later than seventy-two (72) business hours after employment begins. All new hires will be required to verify their employment authorization under oath by signing INS Form I-9 upon commencing employment.)
Indicate all relevant forms of education.

Education - High School

Education - College

Education - Graduate School

Education - Business, Trade or Other School

Training and Skills (Check the skills for which you have had training or experience)

Work References

Please list the names of additional work-related references we may contact. Individuals with no prior work experience may list school or volunteer-related references.
Name
Name
First
Last
(i.e. supervisor, co-worker, etc.)
Name
Name
First
Last
(i.e. supervisor, co-worker, etc.)
Name
Name
First
Last
(i.e. supervisor, co-worker, etc.)

Personal References

Please list the names of personal references (not previous employers or relatives) who know you well, that we may contact.
Name
Name
First
Last
Name
Name
First
Last
Name
Name
First
Last
Have you ever been terminated or asked to resign from any job?
Has your employment ever been terminated by mutual agreement?
Have you ever been given the choice to resign rather than be terminated?

Work Experience

Please list the names of your present and/or previous employers in chronological order with present or most recent employer listed first. Provide information for at least the most recent ten (10) year period. Attach additional sheets if needed. If self- employed, supply firm name and business references. You may include any verifiable work performed on a volunteer basis or internships. You may describe any training or work experience received in any U.S. military service. Your failure to completely respond to each inquiry may disqualify you for consideration from employment. Do not answer "see résumé”.

Address
Address
City
State/Province
Zip/Postal
Country

APPLICANT CERTIFICATION

I understand and agree that if driving is a requirement of the job for which I am applying, my employment and/or continued employment is contingent on possessing a valid driver’s license for the state in which I reside and automobile liability insurance in an amount equal to the minimum required by the state where I reside.

I understand that the Company may now have, or may establish, a drug-free workplace or drug and/or alcohol testing program consistent with applicable federal, state, and local law. If the Company has such a program and I am offered a conditional offer of employment, I understand that if a pre-employment (post-offer) drug and/or alcohol test is positive, the employment offer may be withdrawn. I agree to work under the conditions requiring a drug-free workplace, consistent with applicable federal, state, and local law. I also understand that all employees of the location, pursuant to the Company’s policy and federal, state, and local law, may be subject to urinalysis and/or blood screening or other medically recognized tests designed to detect the presence of alcohol or illegal or controlled drugs. If employed, I understand that the taking of alcohol and/or drug tests is a condition of continual employment and I agree to undergo alcohol and drug testing consistent with the Company’s policies and applicable federal, state, and local law.

If employed by the Company, I understand and agree that the Company, to the extent permitted by federal, state, and local law, may exercise its right, without prior warning or notice, to conduct investigations of property (including, but not limited to, files, lockers, desks, vehicles, and computers) and, in certain circumstances, my personal property.

I understand and agree that as a condition of employment and to the extent permitted by federal, state, and local law, I may be required to sign a confidentiality, restrictive covenant, and/or conflict of interest statement.

I certify that all the information on this application, my résumé, or any supporting documents I may present during any interview is and will be complete and accurate to the best of my knowledge. I understand that any falsification, misrepresentation, or omission of any information may result in disqualification from consideration for employment or, if employed, disciplinary action, up to and including immediate dismissal.

THIS COMPANY IS AN AT-WILL EMPLOYER AS ALLOWED BY APPLICABLE STATE LAW. THIS MEANS THAT REGARDLESS OF ANY PROVISION IN THIS APPLICATION, IF HIRED, THE COMPANY OR I MAY TERMINATE THE EMPLOYMENT RELATIONSHIP AT ANY TIME, FOR ANY REASON, WITH OR WITHOUT CAUSE OR NOTICE. NOTHING IN THIS APPLICATION OR IN ANY DOCUMENT OR STATEMENT, WRITTEN OR ORAL, SHALL LIMIT THE RIGHT TO TERMINATE EMPLOYMENT AT-WILL. NO OFFICER, EMPLOYEE OR REPRESENTATIVE OF THE COMPANY IS AUTHORIZED TO ENTER INTO AN AGREEMENT—EXPRESS OR IMPLIED—WITH ME OR ANY APPLICANT FOR EMPLOYMENT FOR A SPECIFIED PERIOD OF TIME UNLESS SUCH AN AGREEMENT IS IN A WRITTEN CONTRACT SIGNED BY THE PRESIDENT OF THE COMPANY.
Person to contact in case of emergency:
Person to contact in case of emergency:
First
Last

I certify that the above information is true, accurate and complete. I understand that if I misrepresent or leave a fact out in my application I may be refused employment, or if I am employed I may be terminated immediately.