Employment Application

We consider applicants for all positions without regard to race, color, religion, creed, gender, national origin, age, disability, marital or veteran status, or any other legally protected status.

*Position(s) Applied For *Date of Application
*How Did You Learn About Us? If Other *Full Name Street Address: *City: *State: *Zip: Telephone Social Security Number(Voluntary) *Best time to contact you at home? (AM/PM) *If you are under 18 years of age, can your provide proof of your eligibility to work? YesNo *Have you ever filled out an application with us before? YesNo If yes, give date *Have you ever been employed with us before? YesNo If yes, give date *Do any of your friends or relatives, other than spouse, work here?YesNo If yes, state name, relationship and location. *Are you currently employed? YesNo *May we contact your present employer? YesNo *Are you prevented from lawfully becoming employed in this country because of Visa or Immigration Status? (Proof of citizenship or immigration status will be required upon employment)YesNo *Date available for work? *What is your desired salary range? Are you available to work: Full-TimePart-Time *Are you currently on "lay-off" status and subject to recall? YesNo *Can you travel if the job requires it? YesNo *Have you been convicted of a crime within the last 7 years other than a minor traffic offense? YesNo If yes, explain:

Education

*High School

*Name and Address of School *No. of Years Completed *Diploma/Degree

Undergraduate College

Name and Address of School Course of Study No. of Years Completed Diploma/Degree

Graduate/Professional

Name and Address of School Course of Study No. of Years Completed Diploma/Degree

Other (Specify)

Name and Address of School Course of Study No. of Years Completed Diploma/Degree

Additional Information

*State any additional information you feel may be helpful in considering your application, including any job related training in the U.S. Military:

NOTE TO APPLICANTS: DO NOT ANSWER THIS QUESTION UNLESS YOU HAVE BEEN INFORMED ABOUT THE REQUIREMENTS OF THE JOB FOR WHICH YOU ARE APPLYING.

Are you capable of performing in a reasonable manner, with or without a reasonable accommodation, the activities involved in the job or application for which you have applied? A review of the activities involved in such a job or application has been given. YesNo

Work Experience

Start with your present or last job, Include any job-related military service assignments and volunteer activities. Exclude orginizations which include race, color, religion, gender, national origin, disabilities, or other protected status.

*Employer 1

*Company Name *Address *Telephone *Starting/Present Job Title *Supervisor *Reason for Leaving *May We Contact *Dates Employed (From/To) *Hourly Rate (Starting/Final) *Work Performed

Employer 2

Company Name Address Telephone Starting/Present Job Title Supervisor Reason for Leaving May We Contact Dates Employed (From/To) Hourly Rate (Starting/Final) Work Performed

Employer 3

Company Name Address Telephone Starting/Present Job Title Supervisor Reason for Leaving May We Contact Dates Employed (From/To) Hourly Rate (Starting/Final) Work Performed

Personal/Professional References

(Do not include family members or past supervisors)

*Reference 1

*Name *Phone Number *Best Time to Call *Occupation

Reference 2

Name Phone Number Best Time to Call Occupation

Reference 3

Name Phone Number Best Time to Call Occupation

Applicant's Statement

I certify that answers given herein are true and complete.

I authorize investigation of all statements contained in this application for employment as may be necessary in arriving at an employment decision.

This application for employment shall be considered active for a period of time not to exceed 45 days. Any applicant wishing to be considered for employment beyond this time period should inquire as to whether or not applications are being accepted at that time.

I hereby understand and acknowledge that, unless otherwise defined by applicable law, any employment relationship with this organization is of an "at will" nature, which means that the Employee may resign at any time and the Employer may discharge Employee at any time with or without cause. It is further understood that "at will" employment relationship may not be changed by any written document or by conduct unless such change is specifically acknowledged in writing by an authorized executive of this organization.

In the event of employment, I understand that false or misleading information given in my application or interview(s) may result in discharge. I understand, also, that I am required to abide by all rules and regulations of the employer.

*Signature of Applicant *Date