Employment Application Form

    Personal Information

    (Answer all questions in entirety)

    In compliance with Federal and State equal employment opportunity laws, qualified applicants are considered for all positions without regard to race, color, religion, sex, national origin, age, marital status, or the presence of a non-job-related medical condition or handicap.

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    General Information

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    Education

    Please provide the following information about each school you have attended during your educational career.

    High School

    Trade/Technical School

    College/Degree Program

    Other Educational Information

    Please provide any other information we should consider in evaluating your application for employment.

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    References

    Please provide the following information for three(3) individuals who: a) are not related to you; b) you have known at least one year.

    Reference #1

    Reference #2

    Reference #3

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    Employment

    Current/Most Recent Employer

    Employer #2

    Employer #3

    Employer #4

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    Completion & Verification

    Statement of Understanding

    I certify that I personally completed this application, and that the facts contained herein are true and complete to the best of my knowledge. I also understand that, if employed, falsified statements on this application shall be grounds for dismissal. I authorize "COMPANY" to investigate any and all information or statements contained herein, including, but not limited to, work history, alcohol/controlled substance testing, training records, and criminal history. I also authorize any of my listed references and employers to give "COMPANY" any and all information concerning my previous employment and any pertinent information they may have, personal or otherwise, and release "COMPANY" from all liability for any damage that may result from use of such information.

    I also understand and agree that no representative of "COMPANY" has any authority to enter into any agreement for employment for any specified period of time, or to make any agreement contrary to the foregoing, unless it is in writing and signed by an authorized "COMPANY" representative.

    The above waiver does not permit the release or use of disability-related or medical information in any manner prohibited by the Americans with Disabilities Act [ADA] or any other relevant federal and state laws. I have read and understand the above statements and acknowledge by affixing my digital signature below.



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