Employment application

Employment application form

EMPLOYMENT APPLICATION

Step 1 of 5

Date of Application:(Required)

AN EQUAL OPPORTUNITY EMPLOYER

Your Name(Required)

First Last

Address(Required)

Street Address Address Line 2 City State / Province ZIP / Postal Code

Home Phone

Cell Phone(Required)

Email Address(Required)

EMPLOYMENT HISTORY

Please list your present and past work experience for the last 10 years, beginning with your current job. You may include volunteer activities.

Name of Employer(Required)

From(Required)

To(Required)

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Telephone(Required)

Pay**(Required)

Starting

Final

Position(Required)

Description of Duties(Required)

Reason for Leaving(Required)

Name of Employer

From

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Telephone

Pay**

Starting

Final

Position

Description of Duties

Reason for Leaving

Name of Employer

From

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Telephone

Pay**

Starting

Final

Position

Description of Duties

Reason for Leaving

If you need additional space, please continue your response on a separate page.

Please identify and explain all periods of unemployment in excess of one month during the past 10 years:

Period of Unemployment:

From

Reason for Unemployment

To assist us to check records and to verify prior employment and education, please indicate whether you were ever employed or enrolled in a school under a name other than that used on this application

Yes

If yes, please specify the name you were employed or enrolled under

If you are employed now, may we contact your current employer?

Yes

Are you able to perform the essential duties of the position for which you are applying, either with or without reasonable accommodations?

Yes

Are you a veteran of the United States military service?

Yes

If yes, please state branch of service

Please list any job-related professional, trade, business or civic activities, organizations and associations. (You may omit those which indicate race, color, religion, national origin, ancestry, sex, age, the existence of a disability or any other characteristic protected by law.)

Please provide the names, addresses, and telephone numbers of at least two references who are not related to you

Person to be contacted in the event of an accident or emergency(Required)

Name

Address

Telephone

I hereby certify that the information contained in this application form is true and correct to the best of my knowledge and agree to have any of the statements checked by the Company unless I have indicated to the contrary. I authorize the references listed above, as well as all other individuals whom the Company contacts, to provide the Company any and all information concerning my previous employment and any other pertinent information that they may have. Further, I release all parties and persons from any and all liability for any damages that may result from furnishing such information to the Company as well as from any use or disclosure of such information by the Company or any of its agents, employees, or representatives. I understand that any misrepresentation, falsification, or material omission of information on this application may result in my failure to receive an offer or, if I am hired, my immediate dismissal from employment.

In consideration of my employment, I agree to conform to the rules and standards of the Company. I further agree that my employment and compensation can be terminated at will, with or without cause, and with or without notice, at any time, either at my option or at the option of the Company. I understand that no employee or representative of the Company, other than its president, has the authority to enter into any agreement for employment for any specified period of time, or to make any agreement contrary to the foregoing. Further, the president of the Company may not alter the at-will nature of the employment relationship unless the president and I both sign a written agreement that clearly and expressly specifies the intent to do so. I agree that this constitutes an integrated agreement with respect to the at-will nature of my employment relationship, that it is final and fully binding, and that there are no oral, written, or collateral agreements regarding this issue. I also understand that all offers of employment are conditioned on the provision of satisfactory proof of an applicant's identity and legal authority to work in the United States, as well as the satisfactory completion of a post-offer medical examination.

Signature of Applicant(Required)

Date(Required)

UPCOMING EVENTS

Our Board meetings are held on the second Monday of every month, excluding holidays.

Employment application

Employment application form