This is a Drug-Free Workplace Offering Equal Employment Opportunities. Applications are received and employees are hired without regard to race, color, sex, religion, age, genetic information, national origin, 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
Your Work History And Any Employment Gaps
Must be completed even when accompanied by a resume. List the 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 seven years. If you need more space, photocopy page 2 or fill out a separate page and attach it to this form.
More Work History
If you need more space, please photocopy this page or fill out a separate page and attach to this form.
Tell Us About Yourself
You must answer every question on this application. If a question does not apply, put “N/A.” Please print.
(Reasonable accommodation of religious needs that do not create an undue hardship will be considered, if applicable)
(Proof of citizenship status/identity required upon hire)
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
List any special skills, training, experience, certifications, or licenses that may be relevant to this position or our company
List any professional, trade, business, or civic activities or offices held that would relate to working here
List any foreign languages that you fluently speak, read, and/or write that would relate to working here
List software programs that you are proficient in
Your Educational Background
Tell Us About Your Driving Record
If yes, give date(s) and explanation of each:
Tell Us About Your Past
Answering “yes” to any of these questions is not an automatic bar to employment.
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.
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, 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 I will be hired.
I have read, understand, and by my signature consent to these statements:
Your Emergency Contact