Employment Application

It is our policy to provide equal employment opportunities and will not unlawfully consider any factors of race, religion, age, creed, national origin, gender, disability, sexual orientation, veteran status, genetic information or any and all other unlawful biases regarding federal, state or local laws with regard to workers or applicants.

TO BE CONSIDERED FOR EMPLOYMENT, ALL APPLICANTS MUST FILL OUT THIS FORM COMPLETELY. THIS APPLICATION WILL BE GIVEN EVERY CONSIDERATION, BUT ITS RECEIPT DOES NOT IMPLY THAT THE APPLICANT WILL BE EMPLOYED BY OUR COMPANY. THIS FORM BECOMES A PART OF YOUR EMPLOYMENT RECORD IF YOU ARE HIRED. THIS APPLICATION IS ONLY VALID FOR 30 DAYS.

Personal Information
Yes No
If you have lived at the above address for less than 12 months, please list previous address
Yes No
Yes No
Yes No

Work Interest


Full Time Part Time Other:


2nd Shift: 3rd Shift:
Yes No Yes No
Please indicate the hours you are willing to work whenever scheduled or requested?
Yes No Yes No Yes No Yes No

Yes No
Yes No
Yes No Yes No
Work History
List the names of employers in consecutive order with present or last employer listed first. Account for all periods, including military services. If self-employed, give firm name and supply additional references. PLEASE GIVE BOTH MONTH & YEAR.







Yes No

Yes No

Yes No
Education
List All Schools Attended: Name of School Address # of Years Graduated? Degree/Type of Diploma Major/Course of Study
High School:
College/University:
College/University:
Graduate School:
Business/Technical:
Yes No

If you went to college, but did not graduate, how many credit hours are needed for your degree?


Certifications/Licenses
Type Agency or State Issues Date Issued Number
References
Name Address Phone Occupation
Special Skills

Office

Typing wpm: Shorthand wpm: Speed writing wpm: Data Entry? 10-Key?

Computer

Hardware: Software: Other Computer Training:

Employment Application - Affidavit
Additional Terms & Conditions of Employment
Please initial each below:
I certify that the answers given by me to the foregoing questions and statements on the employment application and/or during the employment interview process are true and correct without any consequential omissions of any kind whatsoever. I understand that any misleading or incorrect statements may render this application void and, if employed, would be cause for my termination. I further agree that the Company shall not be liable in any respect if my employment is terminated because of falsity of statements, answers or omissions made by me in this application.
I understand that this application is designed for use with several types of jobs and some questions may not be completely applicable to the position for which I am applying.
I authorize the companies, schools, persons or entities given during the employment process, and the employer (if employed), while employed, or during internal investigations, as references or past employers or affiliations, to give any information regarding my employment, character, qualifications, certifications and licenses, and hereby release said companies, schools, persons or entities from all liability for any damage for issuing this information. A favorable result may be a condition of employment, commencement, or continuation of any employment duties where elements are job-related.
I understand that I may be required to have a medical examination and/or drug and alcohol test after an offer of employment has been made and prior to the commencement of my employment duties. A favorable result on the medical examination and/or drug and alcohol test would be a condition of my employment or commencement of any employment duties as well as any time throughout my employment according to company policy.
I realize that operating conditions may require me to work shifts or work hours scheduled other than the one for which I am applying and I agree to such scheduling change as directed by my supervisor or the management.
I understand that my employment is not for a specified or definite term and that I may resign, or I may be discharged, at any time, for any reason, with or without good cause and with or without prior notice. I further understand that this policy cannot be changed or amended except by written agreement signed by me and by a corporate officer. I understand that this is an application for employment and that no employment contract is being offered.
I understand that only United States citizens or aliens who are legally entitled to work in the United States are eligible for employment.
My employment shall be in accordance with the terms of this application, all safety and incident reporting rules, and all other Company rules and regulations. The Company shall have the right to amend, modify, or revoke its rules and regulations at any time. I will familiarize myself promptly with such rules and regulations and will abide and be bound by the rules and regulations now or hereafter in effect.
I certify that as a part of the application process, I have been provided with a written job description or have had the opportunity to review and/or discuss the requirements for the position of . I certify that I understand each requirement and that I am capable of meeting each and every requirement.