Employment Application

We are an equal opportunity employer
 
  PERSONAL INFORMATION  
 
Full Name:
 
Address:
 
City:
 
State:
 
Zip Code:
 
Social Security No.
  Telephone No.
 
Any Related Employees?
 
 
 
How Did You Learn About Job?
     
  EMPLOYMENT INFORMATION  
 
Position Desired:
 
Date You Can Start:
 
Salary Requirements:
 
Are you Employed Now?
 
If Yes, Where?
 
If Yes, When?
     
  EDUCATION INFORMATION  
  Describe your highest level of education:
  List any self-improvement courses you have taken and plans you have for additional education:
  List any activities, hobbies and clubs that you may be involved with:
  Have you ever been convicted of a criminal offense:
  If Yes, Explain:
  Are you legally authorized to work in the United States
     
  EMPLOYMENT HISTORY  
  List recent employment history with salary and reason for leaving:
  Which former position did you like best and why?
     
  DRIVING RECORD  
  Drivers License No.
  Licensed in what state?
  Name of Insurance Carrier:
  Number of Points on License:
  List any accidents or moving violations in the past 3 years:
  Has your drivers license ever been suspended or revoked?
  If Yes, Explain:
     
  AUTHORIZATION  
  By typing my name in this box, I an acknowledging that I have fully read and agree to everything written in the disclosure  statement below.
     
     
 
Disclosure Statement

This is to inform you that as part of our procedure and processing your application, an investigative report may be made whereby information is obtained through criminal background checks, motor vehicle reports and personal interviews with third parties, such as family members, business associates, financial sources, friends, neighbors, or others with whom you are acquainted. This inquiry includes information as to your character, general reputation, personal characteristics, and mode of living, whichever may be applicable. You have the right to make a written request within a reasonable period of time for a complete and accurate disclosure of additional information concerning the nature and scope of the investigation. You understand that in the event you are hired and it is discovered that you have falsified any information or records given to the company, you may be subject to immediate dismissal.

I authorize investigation of all statements contained in this application. I understand that misrepresentation or omission of facts called for is cause for dismissal. Further, I understand and agree that my employment is for no definite period and may, regardless of the date of payment of my wages and salary, be terminated at any time without previous notice.

If offered a position, you will be required to successfully complete a substance screening as a final condition of employment.

This application does not constitute an offer of employment or a contract of employment. If hired, you will be considered an "At Will Employee"