EMPLOYMENT DESIRED
20-29 Hrs      30+ Hrs      Under 20 Hrs
Availability
Monday      Tuesday      Wednesday      Thursday      Friday      Saturday

Education
High School - Name, City, State

Year Completed Did You Graduate?   Yes      No

Employment
Name, City, State, Phone#

Reason for leaving

Name, City, State, Phone#

Reason for leaving

References
Name, City, State, Phone#

Name, City, State, Phone#

We are an equal opportunity employer. We consider applicants without regard to race, color, religion, sex, national origin, age, marital status, disability, medical condition, sexual orientation, genetic information or any other status protected by law.

Please read carefully, initial each paragraph, and sign below.
Initials1 I hereby certify that I have not knowingly withheld any information that might adversely affect my chances for employment and that the answers given by me are true and correct to the best of my knowledge. I further certify that I, the undersigned applicant, have personally completed this application. I understand that any omission or misstatement of material fact on this application or on any document used to secure employment shall be grounds for rejection of this application or for immediate discharge if I am employed, regardless of the time elapsed before discovery.

Initials 2 I hereby authorize thorough investigation of my references, work record, education, and other matters related to my suitability for employment, and further, authorize the references I have listed to disclose to the company all letters, reports and other information related to my work records, without giving me prior notice of such disclosure. In addition, I hereby release the company, my former employers, and all other persons, corporations, partnerships and associations from any and all claims, demands or liabilities arising out of or in any way related to such investigation or disclosure.

Initials 3 I understand that nothing contained in this application, or conveyed during my interview that may be granted or during my employment if hired, is intended to create an employment contract between the company and me. In addition, I understand and agree that if I am employed, my employment is for no definite or determinable period and may be terminated at any time, with or without prior notice, at the option of either myself or the company, and that no promises or representations contrary to the foregoing are binding on the company unless made in writing and signed by me and the company representatives.

Initials 4 Should personnel employed by the company conduct a search of public records, where required by law, I am entitled to copies of any such public records obtained by the company. If a background check is performed, the company will comply with applicable federal and state background check notice and disclosure procedures.

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ALL RIGHTS RESERVED