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Application for Employment

Employment Experience

Start with your present or last job. Include military service assignments and volunteer activities. Exclude organization names which indicate race, color religion, sex or national origin.

Dates Employed
Hourly Rate/Salary

Dates Employed
Hourly Rate/Salary

Dates Employed
Hourly Rate/Salary
If you need additional space, please continue on a separate sheet of paper.
School Name
Years completed (circle)
Describe course of study

I certify that I am a citizen of the United States, or, if not, I can provide required documentation permitting me to work in the United States. I certify that the facts contained in this application are true and complete to the best of my knowledge. I understand that false, misleading, or omitted information, either in the application or during an interview, whenever discovered, may/shall be grounds for dismissal or rejection of this application. I authorize investigation of all statements contained herein. I authorize current and previous employers and any other person or party to give you any and all information they may have, personal or otherwise. I release all parties from any and all liability for any damage that may result from furnishing this information.

I understand that if I am offered employment, the Company may require me to submit to alcohol and/or drug test(s) as a condition of beginning employment or of continuing employment. In addition, if I am involved in an accident at work, refusal to submit to such test and/or the results of the test may result in my termination and (if permitted under state law) may also limit my ability to recover worker's compensation benefits. I hereby release and agree to indemnify the Company, its employees, officers and agents from any liability arising out of such testing or the taking of any action based on the results of any such testing.

If hired, I agree to abide by the rules and policies of the company. I understand that the policies and benefits of the company do not create any express or implied contract and may be changed by the company at any time without notice. I understand and agree that, if hired, I will always be an at-will employee, that my employment is for no definite period and may, regardless of the date of payment of wages or salary, be terminated at any time with or without cause and without prior notice. I understand that no representative of the company has the authority to enter into an agreement with me that is contrary to the foregoing.