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Personal Information
Name *
Name
Address *
Address
Phone Number *
Phone Number
A conviction will not necessarily disqualify you from employment.
Educational data
Name, City, State and Zip Code
Name, City, State and Zip Code
-Number of Years Completed -Major Course of Study -Degree Completed
Name, City, State and Zip Code
-Number of Years Completed -Major Course of Study -Degree Completed
List any other job-related skills or qualifications that support your application.
EMPLOYMENT EXPERIENCE
List most recent job first
Name, City, State and Zip Code
Employer Phone Number *
Employer Phone Number
Start Date *
Start Date
End Date *
End Date
Name, City, State and Zip Code
Phone Number
Phone Number
Start Date
Start Date
End Date
End Date
Name, City, State and Zip Code
Employer Phone Number
Employer Phone Number
Start Date
Start Date
End Date
End Date
Provide Name to emergency contact: Phone number of emergency contact: Relationship of emergency contact: Address of emergency contact:
Character References
Name/Relationship:
a. NAME b. ADDRESS AND TELEPHONE c. OCCUPATION

NOTICE TO APPLICANTS: This employer complies with the Americans With Disabilities Act of 1990. During the interview process, you may be asked questions concerning your ability to perform job-related functions. If you are given a conditional offer of employment, you may be required to complete a post-job offer medical history questionnaire and/or undergo a medical examination and all information will be kept confidential and in separate files.
 

APPLICANT’S STATEMENT: I certify that the answers given herein are true and complete to the best of my knowledge. I authorize the investigation of all matters contained in this application and hereby give the Employer permission to contact schools, previous employers, references, and others, and hereby release the Employer form any liability as a result of such contact.  I understand that misrepresentations, omissions of facts or incomplete information requested in this application may remove me from further consideration for employment. In addition, if employed, any misrepresentations or omissions of facts called for in this application will be cause for dismissal at any time without any previous notice.

Applicants accepted for employment should clearly understand that while we make every effort to provide steady, continuous work, we have no employment contracts, and we cannot guarantee the permanence of any position. Job tenure can be affected by many factors including business/economic conditions, changes in laws or Employer policies, conformity to our work rules, job performance, etc. And of course, employees may elect to leave on their own accord to seek other jobs.

I understand that my employment with the Employer is for no specific term and may be terminated by me or the Employer with or without notice or cause at any time. I further understand that no oral promise, Employer policy, custom, business practice or other procedure (including the Employer’s Personnel Handbook or any personnel manuals) constitutes an employment contract or modification of the at-will employment relationship between me and the employer.

The contents of any employee handbook or personnel manuals, as well as other Employer policies and practices, are subject to change or modification by the Employer, solely at its discretion, without notice. I also understand that no supervisor or other official of the Employer (except its Chief Executive Officer, in writing) has the authority to enter into any agreement with me or to make any agreement contrary to the foregoing.

We conduct our business with the highest possible degree of safety and efficiency. Because of this, the Employer may require applicants for employment to undergo blood and/or urinalysis screening for drug or alcohol use as part of our pre-placement physical examination. In addition, all employees of the Employer are subject to blood tests or urinalysis screening for drug or alcohol use.

This application will remain active for ninety (90) days. Any applicant wishing to be considered for employment beyond ninety (90) days should reapply.

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This Employer is an equal employment opportunity employer. We adhere to a policy of making employment decisions without regard to race, color, age, sex, religion, national origin, handicap, or marital status. We assure you that your opportunity for employment with this Employer depends solely upon your qualifications.