Application for Employment

All applicants will be considered for employment without regard to race, religion, sex, national origin, age, marital or veteran status, medical condition, or handicap, or any other status protected by law.

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Personal Information

* Last Name

* First Name

Middle Name

* Address

* City

* State

* Zip

* Phone

* E-mail address

Position Information

Education

High School

Name & Location of High School Graduation:

Course of Study

Years Completed

Did you graduate?

College

Name & Location of College:

Course of Study:

Years Completed:

Did you Graduate:

Other Schooling

School Name & Location

Course of Study:

Years Completed: Did you Graduate:

Military Service

Branch of Service:

From:

To:

Date Discharged:

Rank and Duties:

Employment History

List your most recent employers

Most Recent Employer

Employer:

Job Title:

From:

To:

Summarize the nature of work performed and responsibilities:

Starting Pay Rate

Final Pay Rate

Reason for Leaving:

Address:

Telephone:

Immediate Supervisor and Title:

May we contact this person?

Next Most Recent Employer

Employer:

Job Title:

From:

To:

Summarize the nature of work performed and responsibilities:

Starting Pay Rate

Final Pay Rate

Reason for Leaving:

Address:

Telephone:

Immediate Supervisor and Title:

May we contact this person?

Business References

Reference

Name:

Address:

Telephone:

Relationship:

Reference 2

Name:

Address:

Telephone:

Relationship:

Finalize

The above information is true and complete to the best of my knowledge. Should I be employed by the Company, any misrepresentations or false statement contained herein may be considered cause for possible dismissal. The company has my permission to obtain all necessary information about the references I have listed, or any other sources, concerning my prior employment, personal history, or credit standing and I release all parties from any possible damages resulting from disclosing such information with or without prior written notice to me. I reserve the right to know the names and addresses of any investigative agencies used in order that I may learn the information contained in any reports furnished to the company.

All applicants for employment may be required to submit to urinalysis, blood tests or other screening, as part of the Company's pre-employment drug screening process, and prior to the employment physical for the purpose of detecting the presence of alcohol or illegal drugs. Applicants tested will be required to sign a Consent/Release form prior to testing; and, any applicant refusing to sign any required form will be disqualified from further consideration. This alcohol and illegal drug screening will be perfromed by a licensed, certified testing service, and all applicants tested may be required to give a sample of the bodily fluid in the presence of another person, usually an employee of the testing service. A positive test may result in denial of employment.

I understand this application does not constitute an employment contract of any kind. Should I be employed by the Company, I may resign such employment at any time at my discretion with or without prior notice and the Company may terminate my employment at any time at their discretion, with or without cause and with or without notice.

Application For Employment