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Application for Employment

  1. We are an equal opportunity employer. We do not discriminate on the basis of race, religion, gender, age, national origin or disability.
  2. Are you over the age of 18?
      1. Will visa or immigration status prevent lawful employment?
          1. Education
          2. High School
          3. Did you graduate?
          4. College
          5. Did you graduate?
          6. College
          7. Did you graduate?
          8. Other
            Please Specify
          9. Did you graduate?
          10. Skills and Qualifications
          11. Work History
          12. Number 1
          13. May we contact this supervisor for a reference?
          14. Number 2
          15. May we contact this supervisor for a reference?
          16. Number 3
          17. May we contact this supervisor for a reference?
          18. Applicant Signature*
            I certify that the information given by me to (Employer) is true and complete to the best of my knowledge. I understand that if I am employed, discovery that I gave false information during the application process may result in immediate dismissal.

            I authorize (Employer) to solicit information regarding my character, general reputation, credit previous employment and similar background information and to contact any and all references I have given on my application. I hereby release all parties and persons connected with any such request for information from all claims, liabilities and damages for any reason arising out of the furnishing of such information. If employed, I release the company from any liability for future references it may provide regarding my work history with (Employer).

            If employed, I further agree that if (Employer) advances any paid leave before it has been accrued, or advances or loans me any money during the course of employment, or if I lose, damage, or fail to return any (Employer) property, (Employer) is authorized to deduct from my wages sufficient funds to repay such loans or advances or to replace its property.

            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.
          19. Leave This Blank:

          20. This field is not part of the form submission.