Employment Application

Are you presently employed? YesNo

May we contact your present employer? YesNo

Are you available for full time employement? YesNo

Are you a citizen or authorized to work in the U. S.? On an unrestricted basis? (You may be required to provide documentation.) YesNo

Are you looking for full time employment? YesNo

Do you have reliable transportation? YesNo

Do you have any health conditions or restrictions that would preclude you from performing the functions of this position? YesNo

May we contact your previous supervisor for a reference? YesNo

May we contact your previous supervisor for a reference? YesNo

May we contact your previous supervisor for a reference? YesNo

Please read before singning:

I certify that all information provided by me on this application is true and complete to the best of my knowledge and that I have withheld nothing that, if disclosed, would alter the integrity of this application.

I authorize my previous employers, schools, or persons listed as references to give any information regarding my or educational record. I agree that this employer and my previous employers will not be held liable in any if a job offer is not extended, or is withdrawn, or employment is terminated because of false statements, or answers made by myself on this application. In the event of any employment with this employer, I will comply with all rules and regulations as set by this employer, I will comply with all rules and regulations as set by this employer in any communication distributed to the employees.

In compliance with the Immigration Reform and Control Act of 1986, I understand that I am required to provide approved documentation to this employer that verifies my right to work in the United States on the first day of employment. I have received from this employer a list of approved documents that are required.

I understand that employment at this employer is “at will” which means that either I or this employer can terminate the employment relationship at any time with or without prior notice, and for any reason not prohibited by statute. All employment is continued on that basis. I hereby acknowledge that I have read and understand the above statements.