AT-WILL EMPLOYMENT APPLICATION

THIS APPLICATION IS NOT AN EMPLOYMENT CONTRACT but merely is intended to evaluate suitability for employment. It is the policy of the company to provide equal employment to all qualified persons without discrimination on the basis of sex, race, color, religion, age, marital status, national origin, citizenship, disability, veteran status, or any other status protected under state and federal law. It is also the policy of the company to have the option of conducting pre-employment screening before a job offer is made. If a job offer is made, employment may be contingent upon the successful completion of a medical examination, which may include providing body substance samples. This application will remain active for 180 days.

Personal Information

Last name*

First name*

Phone number*

Email*

Please List below your current address:

Street address*

City*

State/Region*

Zip Code*

Since (Mo/Yr)

EDUCATION

High School Attended

City & State

Did you Receive a diploma

Yes

Undergraduate College Attended

City, State

Areas of study

Degree/ Certificate/ Diploma

Additional Education

Please use this tab to fill in any additional training or education.

EMPLOYMENT INFORMATION

Position Applied for:

If other please list.

Date you can start:

Desired Salary $

Do you prefer:

Full Time

Part Time

Can you work

Weekends

Evenings

Please answer all of the following questions. When necessary, use the additional information tab to note question number and provide explanations:

1) Are you at least 18 years of age and Legally eligible for work in the United States

Yes

2) Will you work overtime when necessary?

Yes

3) Have you ever filed an application with us before? :

Yes

If Yes, Give Date:

4) Are you on layoff and subject to recall?

Yes

5) Have you ever been discharged or asked to resign from a job?

Yes

6) Have you ever been convicted of or pled guilty to a felony or other crime?

Yes

7) Are you currently employed?

Yes

8) Have you served in the US Military?

Yes

Please use this tab to elaborate on any of the above topics

EMPLOYMENT HISTORY

May we contact your present employer?

Yes

If yes please list contacts Name, Phone Number, and Position

Please list below your last three employers beginning with the most recent:

Most Recent Employer

City, State, and Zip

Primary Phone Number

Pay Rate Upon Leaving

Supervisor

Supervisor Phone Number

Postion Held

Duties

Reason for Leaving

JOB RELATED SKILLS

Please answer the following questions:

1.Do you have a valid driver's license?

Yes

(If Yes: Driver's License Number)

Date of expiration:

2. Have you been convicted or pled guilty to any traffic related offense within the past five years?

Yes

3.Have you had your driver’s license suspended or revoked or had your driving privileges modified by a court of law?

Yes

4.Please list all states from which you hold or have held a driver’s license:

Please use this space to list any special skills you may have that relate to the position applied for:

Please list personal references with telephone numbers

Reference 1 Name and Phone Number

Reference 2 Name and Phone Number

Reference 3 Name and Phone Number

APPLICANT’S CERTIFICATION AGREEMENT

1. I authorize the investigation of all statements contained in this application and release from all liability any persons or employers supplying such information, and I also release the company from all liability that might result from making the investigation.

2. I certify that the facts and information set forth in this application are true and complete to the best of my knowledge. I understand that any falsification, misrepresentation, or omission of facts on this application (or on any required documents) will be cause for denial of employment or immediate termination of employment, regardless of when or how discovered.

3. I agree, if I am offered and accept a position, to conform to all existing and future Company rules and regulations and I understand that the Company reserves the right to change wages, hours and working conditions as deemed necessary. I ALSO UNDERSTAND THAT, IF HIRED, MY EMPLOYMENT WILL BE AT-WILL, MEANING THAT EITHER PARTY CAN END THE EMPLOYMENT RELATIONSHIP AT ANY TIME AND FOR ANY OR NO REASON.

4. I understand that any employment offer is contingent upon my providing, within three (3) working days of employment, valid proof of identity and eligibility to work in order to comply with the Immigration Reform and Control Act of 1986.

5. I have read and reviewed the information provided in this application and the above statements. By signing this application for employment I certify that I understand all parts of it and have answered all questions completely and fully.