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Employment Application

It is our policy to comply with all applicable state and federal laws prohibiting discrimination in employment based on race, age, color, sex, religion, national origin, disability or other protected classifications. Please carefully read and answer all questions. You will not be considered for employment if you fail to completely answer all the questions on this application. You may attach a résumé, but all questions must be answered.

Personal Information

Are you authorized to work in the U.S. on an unrestricted basis?
Yes
No
Check all that you are willing to work:
Have you ever been convicted of a felony?
Yes
No
Can you perform these essential functions of the job with or without reasonable accommodation?
Yes
No

Education:

Graduated?
Yes
No
Graduated?
Yes
No
Graduated?
Yes
No

References

Reference #1:

Reference #2:

Reference #3:

Employment History

Current Employer:

Start Date
Month
Day
Year
End Date
Month
Day
Year
Still employed there?
Still employed there

Position #2:

Start Date
Month
Day
Year
End Date
Month
Day
Year

Position #3:

Start Date
Month
Day
Year
End Date
Month
Day
Year

I certify that the facts set forth in this Application for Employment are true and complete to the best of my knowledge. I understand that if I am employed, false statements, omissions or misrepresentations may result in my dismissal. I authorize the Employer to make an investigation of any of the facts set forth in this application and release the Employer from any liability. The employer may contact any listed references on this application.


I acknowledge and understand that the company is an “at will” employer. Therefore, any employee (regular, temporary, or other type of category employee) may resign at any time, just as the employer may terminate the employment relationship with any employee at any time, with or without cause, with or without notice to the other party.

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