Job Application

This is a Drug-Free Workplace Offering Equal Employment Opportunities. Applications are received and employees are hired without regard to race, creed, color, sex, religion, age, genetic information, national origin, physical or mental handicap, disability, veteran’s status, citizenship status, or any other protected classes under state, local or county regulations. The receipt of this application does not mean that job openings exist and does not obligate us in any way. We appreciate your interest in our organization.

Your Personal Information


(10MB file size limit)



Your Work History And Any Employment Gaps

Must be completed even when accompanied by resume. List most recent or current job first. You must include any gaps in employment, with a full explanation and dates for the gap. You must also provide a complete work history for a minimum of 15 years. If you need more space, photocopy this page and attach it to the application.



























Add another Employer or Employment Gap


Tell Us About Yourself

You must answer every question on this application. If a question does not apply, put “N/A.” Please print.

 
 
What three things are most important to you in a job?
What three adjectives best describe you?



Tell Us About Your Special Skills And Qualifications




Your Educational Background

Schooling Did you graduate? Years completed Degree received and Major subject Name of School Location



Tell Us About Your Driving Record




Military Service




Non-Compete Agreement




Tell Us About Your Past

Answering “yes” to any of these questions is not an automatic bar to employment.




Tell Us About Any Records



*California Candidates:
  • Do not disclose convictions that have been sealed, expunged, or statutorily eradicated; or for which you were referred to, and participated in, any pre-trial or post-trial diversion program.
  • Do not disclose misdemeanor convictions for which probation has been successfully completed or discharged.
  • Do not disclose convictions that are more than two years old for marijuana possession, possession of marijuana pipes or paraphernalia, operation of a business that displays or sells marijuana paraphernalia in areas accessible to minors and being under the influence of marijuana.
*Connecticut Candidates:
  • Do not disclose erased records of arrests, criminal charges, or convictions.
  • Applicants with erased criminal records can swear under oath that they have never been arrested.
  • Criminal records eligible for erasure include delinquency determinations, findings as a child in a family with service needs, youthful offender adjudications, dismissed or nolled criminal charges, criminal charges where the accused was found not guilty or received an absolute pardon, and any other conviction where erasure is allowed by law.
*Hawaii Candidates:
  • Do not answer this question.
*Massachusetts Candidates:
  • Under Massachusetts law, an employer with six or more employees is prohibited from making written pre-employment inquiries of an applicant about his or her criminal history. MASSACHUSETTS APPLICANTS WHO ARE APPLYING FOR A POSITION AT A COMPANY THAT EMPLOYS 6 OR MORE EMPLOYEES SHOULD NOT RESPOND TO ANY OF THE QUESTIONS SEEKING CRIMINAL RECORD INFORMATION UNLESS:
    • You are applying for a position where federal or state law or regulations creates a mandatory or presumptive disqualification based on a conviction for one or more types of criminal offenses OR
    • The employer or an affiliate is subject by federal or state law or regulations not to employ persons in one or more positions who have been convicted of one or more types of criminal offenses.
    • YOU WILL BE NOTIFIED IF ONE OF THESE EXCEPTIONS EXISTS FOR THE COMPANY/POSITION YOU ARE APPLYING FOR.
*Nevada Candidates:
  • List all felony convictions and any misdemeanor convictions that occurred in the past 10 years and that resulted in imprisonment.
*North Dakota Candidates:
  • List felony convictions only.
*Ohio Candidates:
  • Conviction for a minor misdemeanor violation of the Ohio Rev Code Annotated Section §2925.11 does not constitute a criminal record and need not be reported.
*Pennsylvania Candidates:
  • DO NOT ANSWER THIS QUESTION IF you are applying for a position at a company with 10 or more Philadelphia-based employees.
*Utah Candidates:
  • For any convictions, list only felonies.
*Washington State Candidates:
  • List any convictions or terms of imprisonment within the past 10 years only.


Agreement and Release

For the purpose of this agreement and release, the organization that has provided you with this application is referred to as “the company,” “this company,” or “you” in the following paragraphs:

The facts set forth above in my application for employment are true and complete. I understand that false statements or omission of information on this application (even if discovered after employment) or any other employment form may lead to dismissal or denial of employment. You are hereby authorized to make any investigation of my personal history, financial, criminal, credit, and motor vehicle records through any investigative or credit agencies or bureaus of your choice. You are also authorized to administer a personality profile or other pre-employment tests and verify my background. A criminal record or sentence is not an automatic disqualification for employment. I agree to submit to any drug or alcohol testing prior to or after employment, and I agree to submit to a medical evaluation, if required. I consent to the release of any or all medical information or records deemed necessary to determine my capability to perform the essential job functions of the position for which I may hold.

In making this application for employment, I also understand that an investigative consumer report may be made whereby information is obtained through personal interviews with my neighbors, friends, or others with whom I am acquainted. I also acknowledge that the company may conduct a search for information about me that is in the public domain including, but not limited to, information on social networking sites. In exchange for the consideration of my employment application by this company, I hereby release and forever discharge this company (including its directors, officers, employees, and agents) and my past and/or present employers (including their directors, officers, employees, and agents) from any liabilities which may result from an investigation of my past and/or present employment or from the disclosure of such information. I authorize the use of any information in this application to verify my statements, and I authorize past employers, doctors, all references, and any other persons to answer all questions asked concerning my ability, character, reputation, and previous employment record.

I understand that if my application is accepted and if I am hired, that employment with this company at all times is employment “at will.” It is further understood that this “at will” relationship may not be changed by any written document, verbal statements, or by conduct unless an authorized executive of this company specifically acknowledges such change. I further understand that my “at will” employment may be terminated at any time by this company or myself and includes no guarantee, contract, or promise of employment for any specific length of time. I understand that the first 90 days of employment is a new-hire introductory period. Submission of this application does not imply that you will be hired.

I have read, understand, and by my signature consent to these statements:




Your Emergency Contact

In Case of an Emergency, I Authorize You to Contact: