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Application for Employment

  1. Please enter desired position

  2. Personal Information

  3. Are you 18 years of age or older?*

  4. Employment Desired

  5. Are you employed now?

  6. If so, may we inquire of your present employer?

  7. Have you applied with this company before?

  8. Education

  9. Did you graduate?*

  10. Years Completed

  11. Did you graduate?

  12. Years Completed

  13. Did you graduate?

  14. Years Completed

  15. Did you graduate?

  16. Typing, driver's license, etc.

  17. Civic, athletic, etc. (Exclude organizations, the name or character of which indicates the race, sex, color, or national origin of its members.)

  18. Former Employers

    List your four most recent employers, starting with the last one first.

  19. Employer 1

  20. Estimated

  21. (upon leaving)

  22. Employer 2

  23. Estimated

  24. (upon leaving)

  25. Employer 3

  26. (upon leaving)

  27. References

    List three persons not related to you, whom you have known at least one year.

  28. Person 1

  29. Person 2

  30. Person 3

  31. 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 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, any 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 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.

    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 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, in whole or in part, at any time.

  32. Leave This Blank:

  33. This field is not part of the form submission.