Application for Employment


Yes No

Present Address:

Previous Address:

In case of emergency,  please notify

Employment Desired

Yes No
Yes No
Yes No

Education

Name and Location of school Degree/certificate Subject Studied Grade Average
Yes No Yes No Yes No

Previous Employment:

Date, Month and Year Name, Address and Phone # of Employer Position and job Duties Salary Reason for Leaving
Yes No
Yes No Yes No

Driving Record

Yes No Yes No
Date Location Description Result

References

Name Address Phone no. Business Years acquainted

Terms and Conditions

I hereby certify that all of the facts and information listed on this employment application are true and complete. I understand that any false, incomplete or misleading information given by me on this application is sufficient cause for rejection of this application. I also understand and agree that any such false, incomplete, or misleading information discovered on this application at any time after I am employed may result in my dismissal. I hereby authorize the Company to investigate all statements contained in this application and to interview the references and previous employers listed in this application. I authorize the references and previous employers listed to give the Company all facts, opinions and evaluations concerning my previous employment and any other information they may have, personal or otherwise, and release all such parties from any liability which may allegedly arise from furnishing such information to the Company, including, but not limited to, any liability for defamation or invasion of privacy. I also authorize the Company to conduct and/or obtain a criminal records check and to obtain any available driving record from the Department of Motor Vehicles. If I am offered employment, I understand that such an offer will be conditioned upon satisfactory results of a background investigation and/or Company medical examination or inquiry, including a drug screen test. If then employed, I understand that I will be required to serve a ninety (90) day probationary period. I further understand that my employment and compensation can be terminated, with or without cause or notice, at any time, regardless of the successful completion of my probationary period, at the option of either the Company or myself. I understand that no supervisor or other representative of the Company other than the President of the Company has any authority to enter into any agreement for employment for any specified period of time, or to make any agreement contrary to the foregoing. I also understand that any agreement by the President would be in writing. I further understand and voluntarily agree as a condition of employment or my continued employment that I may be requested by the Company to submit to a urinalysis or other drug screen test, and that my failure to take such test(s) when requested to do so or unsatisfactory test results will disqualify me from consideration for employment, or if I am then employed, may result in my immediate dismissal.