Application for Employment

An Equal Opportunity Employer

Each question should be fully and accurately answered. No action can be taken on this application until all questions have been answered. All information given will be available only to persons who have a "need to know" or as required by law. This company will make reasonable accomodation in the application process, if needed.

* indicates required field

Personal Information

Which type of employment are you seeking?*
Have you ever been convicted of a criminal offense?*
Are you over 18 years of age?*
Are you authorized to work in the United States?*
(Federal Law requires proof of identity and employment authorization for all new employees.)

For Driving Job Only:

Do you have a valid driver's license?
(Federal Law requires proof of identity and employment authorization for all new employees.)

Record of Employment

Current/Most Recent Employer

Are you still employed with this company?*
May we contact this employer for a reference?

Education and Training

Elementary and Jr. High

What is the last grade you completed?*

High School

What is the last grade you completed?*


What is the last year you completed?

Other (Business, Vocational, Military)

What is the last year you completed?

Other Information

This Employment Application is used to notify me that the nature and scope of an investigation, if one is conducted, could include such general identification information as residence verification, and, as applicable, information concerning my employment, education, credit record, general reputation, character, personal characteristics, and habits, and that such information may be developed through personal interviews with third parties such as family members, neighbors, friends, associates, former employers, education institutions, financial sources, custodians of official records or other sources. Only job-related information developed from such a report will be considered in evaluation my employment application or continued employment. I hereby authorize these persons, companies, organizations or corporations to answer all questions or release any information regarding the items listed in this paragraph. I hereby release them from any liability and hold them harmless from any claim for releasing any truthful information within their knowledge and/or records.

I authorize the Company to release to any person, firm, entity or organization with whom I may seek employment in the future, any truthful information concerning my work experience with the Company. I hereby release and hold the company harmless from any claim for releasing any trutful information within its knowledge and/or records.

I understand that any job offer that may be extended to me will be contingent upon the successful completion of a drug and alcohol test.

I certify that the answers given by me to the foregoing qustions and during any interviews are true and correct without conswquential omissions, and understand that, if employed, omission and/or false statements on this application or during any interviews may result in dismissal. I understand and agree that, if hired, my employment is for no definite period and either the Employer or I may terminate our relationship at will at any time, without notice or any reason, and that this employment application does not constiture an employment contract. I have had an opportunity to have my questions about this statement's content and intent answered and understand its terms.

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