We consider applicants for all positions without regard to race, color, religion, sex, national origin, age, disability, veteran status or any other legally protected status.

Position(s) applied for:

How did you find out about this position?

Why are you seeking a new position at this time?

Applicant Information

If hired, do you have a reliable means of transportation to get to work?     Yes    No  

Are you at least 18 years old?     Yes    No  

If you are under 18 years of age, can you furnish a work permit?     Yes    No  

If the position you are applying for requires driving

Are you legally eligible for employment in the U.S.?     Yes    No  
(Proof of U.S. citizenship or immigration status is required if hired.)

Have you been convicted of a crime?     Yes    No  

If yes, state the nature of the offense and disposition of the case. Include dates and places. (NOTE: The existence of a criminal record does not constitute an automatic bar to employment.)

Are you a veteran?     Yes    No  

If yes, give dates of service

List any special skills or training

Employment Information

Are you seeking:     full time    part time    temporary

What hours and shift(s) would you prefer to work?

List times you are not available to work:

Are you willing to work overtime?     Yes    No  

Weekends?     Yes    No  

Holidays?     Yes    No  

Are you currently employed?     Yes    No  

If hired, when would you be able to start?

Have you ever worked for this organization before?     Yes    No  

If yes, name used:

List any friends or relatives employed by this company:

Have you ever been discharged or asked to resign from any position?     Yes    No  

If yes, please describe:

Education (check highest level achieved)

Elementary:     1    2    3    4    5    6    7    8  

Secondary:     9    10    11    12  

If in high school, were you enrolled in a recognized co-op program?     Yes    No  

If yes, identify program and school:

College:     1    2    3    4    5    6  

Work History (please begin with most recent)





For references purposes: Have you worked for any of these organizations or attended school under a different name?     Yes    No  

If yes, give name and organization(s)

May we contact the employers listed above?     Yes    No  

If not, list the employers you do not wish us to contact and why:

Authorizations & At-Will Employment Agreement
(please read carefully, then sign and date below)

I certify that I have personally completed this application. I declare that the information provided in this employment application is true and complete and I understand that any false information or significant omissions may disqualify me from further consideration for employment and may be justification for my dismissal from employment if discovered at a later date. I agree to immediately notify this company if I should be convicted of a crime while my application is pending or during my employment, if hired.

I authorize this company to make an investigation of all information contained in this employment application and I release from li-ability all companies and corporations supplying such information. I understand any false answers, statements, or implications made by me on this application or other required documents shall be considered sufficient cause for denial of employment or discharge.

I specifically authorize and direct my current and former employers to supply employment-related information to this company and do hereby release my current and former employers from liability for providing information to this company.

Upon termination of my employment for whatever reason, I release this company from all liability for supplying any information concerning my employment to any potential employer.

I authorize this company, if applicable, to request a copy of my credit report, motor vehicle driving record, and any other investiga-tive report deemed necessary through various third party sources. As required by law, upon request within a reasonable period of time, I will be notified as to the nature and scope of such investigations.

I hereby agree to submit to any drug test required of me, whether prior to my employment or if employed by this company at any time thereafter. The Company reserves the right to grant conditional position offers, which are conditioned on a medical examina-tion conducted in accordance with applicable law. The Company may further require the medical evaluation of an employee, in the event the Company reasonably believes that a condition or situation exists that poses or might pose a direct threat.

I understand and agree that nothing contained in this application, or conveyed during any interview is intended to create an employment contract between the company and me. In addition, I understand and agree that if you employ me, in consideration of my employment, my employment and compensation will be at-will, for no definite period of time, and may be terminated at any time, for any reason, or for no reason at all. I understand that only the company’s President is authorized to change the employment-at-will status and such a change can only be done in writing. I have read, understand, and agree to the above.