Employment Application

Please submit your information below for consideration of employment.

 
Personal Information
Name *
Name
Address *
Address
Phone *
Phone
Previous Employment Record #1
Company Address
Company Address
Contact Name
Contact Name
Contact Phone Number
Contact Phone Number
$
$
Previous Employment Record #2
Company Address
Company Address
Contact Name
Contact Name
Contact Phone Number
Contact Phone Number
$
$
Education
Other Information
Please submit any other information that you feel would be important for us to know.
Acknowledgements
Medical Information *
After an offer of employment is made, but before employment duties begin, applicants may be required to undergo a physical or medical examination (or drug test) by a Company-chosen physician, with the offer of employment conditioned on the result of such examination. Employees, at any time during the course of their employment, may be required to undergo a medical (or drug) examination by a Company-chosen physician. I authorize the physician conducting the examination and any laboratory testing any specimen obtained by the physician to disclose the results of the examination and the laboratory test to the Company. By checking the box below you certify that you are able to perform the essential functions of this job with or without reasonable accommodation.
Related Party *
Are you related to or are you associated with anyone working for the company?
Certification
*
By checking the box below, I certify that all statements made on this application are true and complete to the best of my knowledge. I understand that my application will not be considered if it is incomplete. Further, I understand that any misrepresentation or omission made herein, when discovered, will subject me to discharge. I authorize the Company to investigate my work history, education, character, reputation, and background as it deems necessary for purposes of considering my application for employment. In exchange for the Company’s consideration of my application for employment, I hereby release the Company and all providers of information (including, but not limited to, any of my former employers, educational institutions attended, and personal references) from all liability relating to or arising out of any inquiry by the Company regarding my work history, education, character, reputation, and background. This application is not a contract of employment and cannot create a contract of employment for any specific period. I understand that if I am employed, my employment is “at will” and can be terminated at any time, either by myself or the Company, with or without cause or reason and with or without notice.
I acknowledge that by entering my name I am digitally signing this application for review as of the date listed below.
Signed Date *
Signed Date

*It is the policy of this Company to hire only U. S. citizens and aliens who are authorized to work in this country. (As a condition of employment, you will be required to produce original documents establishing your identity and authorization to work, and to complete the U.S. Immigration and Naturalization Service’s Form I-9.)