Application for Employment

Conviction will NOT necessarily disqualify you for employment. Each instance and explanation will be considered in relation to the position for which you are applying.

Employment History

Provide the following information for your past and current employer or volunteer activities starting with the most recent.

Education Background

Name And Location Of School

Number Of Years Completed

Did You Graduate

Course of Study


List name and telephone number of three-business/ work/ or school references who are not related to you.



Number of years known

Skills and Qualifications:

Summarize any training, skills, licenses and/or certificates that may qualify you as being able to perform job-related functions in the position for which you are applying.

Applicant Statement

I certify that all information I have provided in order to apply for and secure work with the employer is true, complete and correct.
I understand that any information provided by me that is found to be false, incomplete or misrepresented in any respect, will be sufficient cause to cancel further consideration of this application, or immediately discharge me from employers service, whenever it is discovered.
I expressly authorize, without reservation, the employer, its representatives, employees or agents to contact and obtain information from all references
(personal and professional), employers, public agencies, licensing authorities and educational institutions and to otherwise verify the accuracy of all
information provided by me in this application, resume or job interview. I hereby waive any and all rights and claim I may have regarding the
employer, its agents, employees or representatives, for seeking, gathering and using such information in the employment process and all other person,
corporations or organizations for furnishing such information about me.
I understand that the employer does not unlawfully discriminate in employment and no question on this application is used for the purpose of limiting
or excusing any applicant from consideration for employment on a basis prohibited by applicable local, state or federal law.
I understand that this application remains current for only 30 days. At the conclusion of that time, if I have not heard from the employer and wish to be
considered for employment, it will be necessary to reapply and fill out a new application.
If I am hired, I understand I am free to resign at any time, with or without cause and prior notice, and the employer reserves the same right to terminate
my employment at any time, with or without cause and without prior notice, except as may be required by law. This application does not constitute an
agreement or contract for employment for any specified period or duration. I understand that no supervisor or representative of the employer is
authorized to make any assurances to the contrary and that no implied, oral or written agreements contrary to the foregoing express language are valid
unless they are in writing and signed by the employers president.
I also understand that if I am hired, I will be required to provide proof of identity and legal authority to work in the United States and federal
immigration laws require me to complete an I-9 form in this regard.


I certify that I have read, fully understand and accept all terms of the foregoing applicant statement.