Personal Information
Name
Address
Contact Information
Position
Work Eligbility
Background
Answering "YES" to these questions does not constitute and automatic bar to employment. Factors such as
date of the offense, seriousness of the violation, rehabilitation and position applied for will be taken into
account.
Drivers License
Employment History
List last employer first, including US military service.
First Previous Job:
Previous Employer
Previous Supervisor
Hourly Rate / Salary:
Second Previous Job:
Previous Employer
Previous Supervisor
Hourly Rate / Salary:
Third Previous Job
Previous Employer
Previous Supervisor
Hourly Rate / Salary:
Skills and Qualifications
Educational Background:
References
Application Statement
I certify that all information I have provided in order to apply for and secure work with the employer is true, complete, and correct.
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) cancel further consideration of this application,
or (ii) immediately discharge me from the employer’s service, whenever it is discovered.
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 educational 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 have
regarding the employer, its agents, employees or representatives, for seeking, gathering and
using such information in the employment process and all other persons, corporations or organizations for
furnishing such information about me.
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 to reapply and fill out a new application.
If I am hired, I understand that I am an "at will" employee where as I am free to resign at any time, with or without
causes and without prior notice and the employer resaves the same right to terminate
my employment at any time, with or without cause and without prior notice, unless
otherwise 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 assurance 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 authority to work in the
United States and federal immigration laws require me to complete an I-9 Form inthis regard.
DO NOT SUBMIT UNTIL YOU HAVE READ THE ABOVE APPLICANT STATEMENT.
I certify that I have read, fully understand and accept all terms of the foregoing Applicant Statement.