Are you 18 years of age or older?
Are You Employed Now?
Are If So May We Inquire
of Your Present Employer?
Ever Applied to this Company Before?
Trade, Business or
List below your last four employers, starting with the last one first.
List below three persons not related to you, whom you have known at least one year.
If you are to be hired by the company, you will be required to attest to your identity and employment eligibility, and to present documents
confirming your identity and employment eligibility. You cannot be hired if you cannot comply with these requirements.
I certify that the facts contained in this application (and accompanying resume, if any) are true and complete to the best of my knowledge. I understand
that any false statement omission, or misrepresentation on this application is sufficient cause for refusal to hire, or dismissal if I have been employed, no
matter when discovered by the Company.
I understand that any employment is conditioned on a background check. I authorize the Company to thoroughly investigate all statements contained in
my application or resume, and I authorize my former employers and references to disclose information regarding my former employment, character and
general reputation to the Company, without giving me prior notice of such disclosure, In addition, I release the Company, any former employers and all
references listed above from any and all claims, demands or liabilities arising out of or related to such investigation or disclosure.
I understand and agree that nothing contained in this application, or conveyed during any interview, is intended to create an employment
contract. I further understand and agree that if i am hired, my employment will be “at will” and without fixed term, and may be terminated
at any time, with or without cause and without prior notice, at the option of either myself or the Company. No promises regarding employment
have been made to me, and I understand that no such promise or guarantee is binding upon the Company unless made in writing.
If I am offered employment I agree to submit to a medical examination and drug test before starting work. If employed, I also agree to submit to a medical
examination or drug test at any time deemed appropriate by the Company and as permitted by law. I consent to such examinations and tests, and I
request that the examining doctor disclose to the Company the results of the examination, which results shall remain confidential and segregated from my
personnel file. i understand that my employment or continued employment, to the extent permitted by law, is contingent upon satisfactory medical
examinations and drug test, and if I am hired a condition of my employment will be that I abide by the Company’s Drug and Alcohol Policy.
I understand that filing out this form does not indicate there is a position open and does not obligate the Company to hire. If hired I agree to abide by
all Company work rules policies and procedures. The Company retains the right to revise its policies or procedures in whole or in part, at any time.