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.
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.
You must answer every question on this application. If a question does not apply, put “N/A.” Please print.
Answering “yes” to any of these questions is not an automatic bar to employment.
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:
In Case of an Emergency, I Authorize You to Contact:
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