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Date of Application
Jun 03, 2023

NOTICE TO APPLICANTS

Drug/Alcohol testing is required as part of the employment process.

* First Name

Middle

* Last Name

* Street Address

* City

* State

* Zip

* Home Phone

Cell Phone

* Email

* Type of employment desired Full Time Part Time Temporary Internship Other

* Position applying for

* Shift preferred 1 2 3 Any

* Date available for work

* Expected salary range

* Referral source Website/Internet Employee/Friend Walk-in Ad Other

Name of referral source

* Have you submitted an application here before?

Yes No

If yes, provide date & position

* Have you ever been employed here before?

Yes No

If yes, provide date & position

* Are you legally eligible for employment in the USA? If yes, proof is required if hired

Yes No

* If you are under 18 years old, Can you provide a work permit if required?

Yes No

* Are you able to perform the 'essential functions' of the job for which you are applying for (with or without reasonable accomodation)?

This question is not designed to elicit information about an applicant’s disability. Please do not provide information about the existence of a disability, particular accommodation, or whether accommodation is necessary. These issues may be addressed at a later stage to the extent permitted by law.

Yes No Need more information about the jobs "essential functions" to respond

Explain any gaps in employment, other than those due to personal illness, injury or disability

* Have You Been Fired or Asked to Resign From a Job?

Yes No

If Yes Explain

* Have you ever been convicted of a felony, for any violation(s) of law, including traffic violations?

Yes No

If yes, please provide the following: Description of offense, date of conviction, county, city and state of conviction

Will you be uploading a resume? Yes No. I will enter my recent employment and education information below.

References

Application Statement

I certify that all information submitted by me on this application is true, correct, and complete, and I understand that if any false or misleading information omissions, or misrepresentations are discovered, my application may be rejected, and if I am employed, my employment may be terminated at any time.

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 claims I may have regarding the employer, its agents, employees or representatives, for seeking, gathering and using truthful and non-defamatory information , in a lawful manner, in the employment process and all other persons, corporations or organizations for furnishing such information about me.

In consideration of my employment, I agree to conform to the company’s rules and regulations, and I understand that these rules and/or the employee handbook do not form a contract of employment, either expressly or implied, and I agree that my employment and compensation can be terminated with or without cause and with or without notice, at any time, at either my or the company’s option. I also understand and agree that the terms and conditions of my employment may be changed with or without cause and with or without notice, at any time by the company. I understand that no company representative, other than its president, and then only when in writing and signed by the president, has any authority to enter into any agreement for employment for any specific period of time, or to make an y agreement contrary to the foregoing.

I understand that this application remains active for 30 days. At the conclusion of that time, if I still wish to be considered for employment, it will be necessary to reapply and fill out a new application.

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 that federal immigration laws require me to complete an I-9 Form in this regard. Also, if employed, I understand the Company has the right to conduct post-accident, and/or reasonable suspicion, drug and/or alcohol testing of its employees.

Name/location of School	Course of Study	Last Year Completed	Graduated
		High School 9 10 11 12	Yes No
		College 1 2 3 4	Yes No
		Vocational Training 1 2 3 4	Yes No
		Other 1 2 3 4	Yes No

	Name and Occupation	Relationship	Phone Number	E-mail	Years Known
1
2
3
4

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Resume

Work History

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References

Application Statement

I have carefully reviewed the above certification and I understand and agree to its terms.

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APPLICATION FOR EMPLOYMENT

Resume

Work History

Education

Skills and Qualifications

References

Application Statement

I have carefully reviewed the above certification and I understand and agree to its terms.

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