Last Name (required) First Name (required) Other Name(s) Used Home Phone Business/Message Phone Address City, State & Zip Email (required) Position Applied For Referred By Salary Desired Previous Interviews Have you ever interviewed with the company or its affiliates before? If Yes, enter Date, Job Title, Location If Yes, enter Date, Job Title, Location Previous Employment Have you ever been employed with the Company or its affiliates before? If Yes, enter Date, Job Title, Location If Yes, enter Date, Job Title, Location Relatives Employed Here Do you have any relatives employed by the Company or its affiliates? If Yes, enter Date, Job Title, Location If Yes, enter Date, Job Title, Location Are you at least 18 years old? If under 18, do you have a work permit? Contact Permission May we contact your current employer for references? Overtime If hired, will you be able to work overtime? Job Performance Will you be able to perform the essential job functions for the position you are applying for with or without reasonable accommodation? Have You Ever Been Convicted Of Any Crime? Have you ever been convicted of any crime, (excluding convictions for marijuana related offenses for personal use more then two years old, convictions that have been sealed, expunged, or legally eradicated or misdemeanors for which probation was completed and the case was dismissed by court)? (Note: A Yes response does not automatically disqualify your application.) If Yes, please explain Are You Currently Pending Trial? Are you currently out on bail or released on your own recognizance pending trial? If Yes, please explain Resume You May Paste Your Resume Here (optional) If you have a resume, please paste it into the box below. It has to be in plain text format. Certification & Authorization
The above information is true and correct. I understand that the hiring process will be terminated, or in the event of my employment by the Company, I shall be subject to dismissal, if any information that I have given in this application, the background release form, if any resume or interview or any part of the hiring process is false or misleading or if I have failed to give any information herein requested, or if I have withheld relevant information, regardless of the time elapsed after discovery.
I authorize the Company to inquire into my educational, professional and past employment history references as needed to research my qualifications for this position. I hereby give my consent to any former employer to provide employment-related information about me to the Company and will hold the Company and my former employer harmless from any claim made on the basis that such information about me was provided or that any employment decision was made on the basis of such information. I further authorize the Company to obtain any credit and consumer check. I understand that the Company will provide a separate Disclosure and Release by law that will permit the Company to make such inquires through the services of a third party.
I understand that nothing in this employment application, the granting of an interview or my subsequent em- ployment with the Company is intended to create an employment contract between myself and the Company under which my employment could be terminated only for cause. On the contrary I understand and agree that, if hired; my employment will be terminable at will and may be terminated by me or the Company at any time and for any reason. I understand that no person has any authority to enter into any agreement contrary to the foregoing.
If employed, I will be to provide original documents which verify my identity and right to work in the United States under the Immigration Reform and Control Act (IRCA) of 1986. The document(s) provided will be used for completion of Form I-9.
I hereby acknowledge that I have read and agree to the above statements.
Signature (required) Enter your name here in place of signature Date (required) Enter today's date