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APPLICATION FOR EMPLOYMENT

(WE ARE AN EQUAL EMPLOYMENT OPPORTUNITY EMPLOYER)

APPLICANT’S STATEMENT: I understand that the Company is committed to providing equal opportunity in all employment practices,
including but not limited to selection, hiring promotion, transfer, and compensation to all qualified applicants and employees without
regard to age, race, color, national origin, sex, religion, handicap or disability, citizenship status, service member status, or any other
category protected by federal, state, or local law.

I authorize former and present employers, and professional, work, and personal references listed in the application and any other
individuals I may name, to give the Company or its designee any and all information concerning my previous employment and any
pertinent information they may have, personal or otherwise, and release such parties from all liability for any damages that may result
from furnishing same to the Company. I also authorize the Company to provide truthful information concerning my employment with it
to future employers, and I agree to hold it harmless for providing such information.

I understand that the Company reserves the right, to the extent permitted by law, to require drug and alcohol screening tests of an
applicant or an employee either prior to employment or any time during employment, and I hereby give my consent to any such tests. I
consent to the release of the results of any such tests to the Company or its designee. I release the Company and its designee from
any and all liability and damages that may result or arise from any drug test or the provision of information in connection with such a
test.

I UNDERSTAND THAT THIS EMPLOYMENT APPLICATION AND ANY OTHER COMPANY DOCUMENTS ARE NOT PROMISES
OF EMPLOYMENT AND THAT I AM AN AT-WILL EMPLOYEE. I FURTHER UNDERSTAND THAT, IF I AM EMPLOYED, I CAN
TERMINATE MY EMPLOYMENT AT ANY TIME WITH OR WITHOUT CAUSE AND WITH OR WITHOUT ADVANCE NOTICE AND
THAT THE COMPANY HAS A SIMILAR RIGHT. I UNDERSTAND THAT NO MANAGER, REPRESENTATIVE, OR AGENT OF THE
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, EXCEPT THAT THE PRESIDENT MAY DO SO IN
WRITING
.

I certify that the information given by me on this application and during the interview process is true and complete in all respects, and I
agree that if the information is found to be false, misleading, or unsatisfactory in any respect (in the Company’s judgment) that I will be
disqualified from consideration for employment or subject to immediate dismissal if discovered after I am hired.
This application will be considered “active” for a maximum of thirty (30) days. If you wish to be considered for employment after that
time, you must reapply.

DO NOT SIGN UNTIL YOU HAVE READ AND UNDERSTAND THESE STATEMENTS




Date


Applicant’s Signature

Each inquiry on this application must be fully answered or completed. Otherwise, you will not be considered for employment

PERSONAL INFORMATION






























 

PREVIOUS EMPLOYMENT

Please list the names of your present or previous employers in chronological order with present or last employer listed first. Include parttime
and seasonal employment. If self-employed, give firm name and supply business references. DO NOT ANSWER “SEE RESUME.”
Fill out this form completely.













































BACKGROUND INFORMATION

Please explain fully any gaps in your employment history. Be sure to account for all periods of time including military service and any
period of unemployment.

List any other names which you may have used and which will be necessary to verify prior to your employment:










If yes, please explain circumstances:












Note – For the questions below, do not answer “Yes” or provide any information regarding expunged arrests, expunged charges,
or expunged convictions.













(NOTE: Answering “yes” to these questions does not constitute an automatic bar to employment.) If you answered yes to any of the
preceding questions, please give dates and details:






EDUCATION









College/University














OTHER INFORMATION

Please describe any other experience that you have which would be relevant to the job for which you are applying:

DRIVING INFORMATION

(Complete only if driving is an essential function of the job for which you are applying).






































Please list all moving traffic violations in the last five (5) years:

  • Offense
  • DATE
  • LOCATION
  • COMMENTS