293 Main Street
APPLICATION FOR EMPLOYMENT
An Equal Opportunity Employer
We do not discriminate on the basis of race, color, religion, national origin, sex. age. disability , or any other status protected by law or regulation. It is our intention that all qualified applicants be given equal opportunity and that selection decisions be based on job-related factors
Answer each question fully and accurately . No action can be taken on this application until you have answered all questions. Use blank paper if you do not have enough room on this application. PLEASE PRINT, except for signature on back of application. In reading and answering the following questions, be aware that none of the questions are intended to impl) illegal preferences or discrimination based upon non-job-related information.
(If you are hires, you may be required to submit proof of age.)
List professional, trade, business or civic activities and offices held. (Exclude labor organizations and memberships which reveal race. color. religion. national origin. sex. age. disability or other protected status.)
LIST NAME AND ADDRESS OF SCHOOLS
Number of Years Completed,
Diploma Degree Certificate,
List names of employers in consecutive order with present or last employer listed first. Account for all periods of time including service and any periods of unemployment. If self-employed, give firm name and supply business references. Note : A job offer may be contingent upon acceptable references from current and former employers. including military service and any periods of unemployment.
Give three references. not relatives or former employers.
PLEASE READ EACH STATEMENT CAREFULLY BEFORE SIGNING
I certify that all information provided in this employment application is true and complete. I understand that any false information or omission may disqualify me from further consideration for employment and may result in my dismissal if discovered at a later date.
I authorize the investigation of any or all statements contained in this application. I also authorize. whether listed or not. Any person, school. current employer. past employers and organizations to provide relevant information and opinions that may be useful in making a hiring decision. I release such persons and organizations from any legal liability in making such statements.
I understand I may be required to successfully pass a drug screening examination. I hereby consent to a pre-and or post-employment drug screen ah condition of employment. if required.
I understand that if I am extended an offer of employment it may be conditioned upon my successfully passing a complete pre-employment physical examination. I consent to the release of any or all medical information as may be deemed necessary to judge my capability to do the work for which I am applying.
I UNDERSTAND THAT THIS APPLICATION, VERBAL STATEMENTS BY MANAGEMENT, OR SUBSEQUENTEMPLOYMENT DOES NOT CREATE AN EXPRESS OR IMPLIED CONTRACT OF EMPLOYMENT NOR GUARANTEE EMPLOYMENT FOR ANY DEFINITE PERIOD OF TIME. ONLY THE PRESIDENT OF THE ORGANIZATION HAS THE AUTHORITY TO ENTER INTO AN AGREEMENT OF EMPLOYMENT FOR ANY SPECIFIED PERIOD AND SUCH AGREEMENT MUST BE IN WRITING, SIGNED BY THE PRESIDENT AND THE EMPLOYEE. IF EMPLOYED. I UNDERSTAND THAT I HAVE BEEN HIRED AT THE WILL OF THE EMPLOYER AND MY EMPLOYMENT MAY BE
TERMINATED AT ANY TIME, WITH OR WITHOUT REASON AND WITH OR WITHOUT NOTICE.
This a application will remain active for a limited time.