Employment Application

INSTRUCTIONS TO APPLICANT:
Please fill in all spaces. Failure to do so may result in your application not being considered. If an item does not apply, simply type "N/A".

You must complete your own application.

We Are An Equal Opportunity Employer

**ALL fields are required for your application to be considered **

First and Last Name:

e-mail:

Phone:

Cell Phone:

Address:

City:

State:

Zip Code:

Position Applying For:

Wage or Salary Desired:

Type of employment desired:

Can you work weekends?

Do you have the legal right to work in the United States?

(Note: If hired, proof of status will be required)

Have you ever been convicted of a crime by a civilian or military court (other than minor traffic violations?)

If Yes to the question above, please give details:

(Conviction of a crime is not an automatic bar to employment. All circumstances will be considered.)

Do you have any friends or relatives currently working here? If so, what is their name?

EMPLOYMENT HISTORY - List all work history, beginning with the most recent. Include period(s) of military service. If any information is not recalled, please note. Please complete this section even if you have furnished a resume.

Employment History 1 Dates Employed: From (MM/DD/YYYY): To (MM/DD/YYYY): Employer's Name: Employer's Address and phone #: Supervisor's Name:	Salary: Starting: Final: Your job title and duties: Reason for leaving:
Employment History 2 Dates Employed: From (MM/DD/YYYY): To (MM/DD/YYYY): Employer's Name: Employer's Address and phone #: Supervisor's Name:	Salary: Starting: Final: Your job title and duties: Reason for leaving:
Employment History 3 Dates Employed: From (MM/DD/YYYY): To (MM/DD/YYYY): Employer's Name: Employer's Address and phone #: Supervisor's Name:	Salary: Starting: Final: Your job title and duties: Reason for leaving:
Employment History 4 Dates Employed: From (MM/DD/YYYY): To (MM/DD/YYYY): Employer's Name: Employer's Address and phone #: Supervisor's Name:	Salary: Starting: Final: Your job title and duties: Reason for leaving:
Employment History 5 Dates Employed: From (MM/DD/YYYY): To (MM/DD/YYYY): Employer's Name: Employer's Address and phone #: Supervisor's Name:	Salary: Starting: Final: Your job title and duties: Reason for leaving:

EDUCATION Name and Address of HIGH SCHOOL:	Years completed? Graduated?
Name and Address of COLLEGE: Course of study:	Years completed? Graduated? Degree:
Name and Address for ADDITIONAL/OTHER SCHOOLING: Course of study:	Years completed? Graduated? Degree:

List any additional work experience, education, skills, information, licenses, certifications, special study or research work relating to the position applied for or of general interest:

PROFESSIONAL REFERENCES - List three business people, professionals or teachers. Do not list relatives, friends, or employees of this company.

Reference 1 (Please include: Name, Address, Phone number and how long known):

Reference 2 (Please include: Name, Address, Phone number and how long known):

Reference 3 (Please include: Name, Address, Phone number and how long known):

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All Applicants are considered for employment without regard to race, color, sex, age, religion, national origin, disability or military veteran status or any other category protected by federal, state and local laws.

IMPORTANT: READ CAREFULLY

I hereby authorize all of my prior employers, credit bureaus, the officials of all schools which I have attended or been associated with, any person named on this application form, all public officials, and any other person or entity to give any information regarding my employment, personal habits, ability, criminal record or any other relevant information they may have regarding my employment, personal habits, ability, criminal record, or any other relevant information they may have regarding me whether or not it is on their records. I hereby release said employers, schools, public officials and other persons and entities, from any and all liability for any damage whatsoever which might result from their revealing or furnishing this information.

I understand that an investigation may be made whereby information is obtained through personal interviews with neighbors, friends and others with whom I am acquainted, as well as from credit bureaus. This may include information as to character, general reputation, personal characteristics, credit history or mode of living. I know that I have a right to make a written request within a reasonable period of time for a complete and accurate disclosure of information concerning the nature and scope of this investigation.

I understand and accept that as a part of the application and employment process, and/or during employment with the Company, I may be asked to submit to physical examinations, testing for alcohol/drugs, and have a background check completed, all in accordance with law. By signing this application, I hereby agree to submit to such examinations and release all persons and companies from any liability arising out of such examinations, tests and background checks. I further agree that the examining person may disclose to the Company or its representative the results of same.

If employed, I agree to conform to all policies, practices and procedures of the Company and acknowledge that these may be changed, interpreted, withdrawn, or amended by the Company at any time, at the Company's sole option and without any prior notice to me. I consent and agree that the Company shall have the right to search my personal property located on Company property, along with Company desks, lockers, etc. for the purpose of investigating possible violations of Company rules/policies. This also includes access to my telephone conversations and e-mails or other types of electronic communications.

I further acknowledge that my employment, or any offer of employment, if such is made, may be terminated, with or without cause, and with or without prior notice, at any time, at the option of the Company or myself. Employment, therefore, is on an "at will" basis. I understand that no representative of the Company has any authority to enter into any agreement with me of any nature and do hereby state that none has so been asserted to me by anyone.

I HEREBY STATE THAT ALL FACTS GIVEN ARE CORRECT TO THE BEST OF MY KNOWLEDGE AND ANY MISREPRESENTATION OR OMISSION ON MY PART IS CAUSE FOR REJECTION OR TERMINATION.