A Drug and Alcohol Free Workplace

Instructions: We appreciate your interest in our organization. We consider applicants for all positions without regard to race, color, religion, age, sex, disability, national origin, genetic information, U.S. military service or any other state protected group.

Personal Information

(Conviction will not necessarily disqualify an applicant)

Employment Desired

Education

Elementary School

High School

College

Trade, Business or Correspondence School

References

Give name, address and a telephone number of three references who are qualified to evaluate your capabilities and who are not related to you and are not previous employers.

Membership in professional or civic organizations:

(Exclude those which may disclose your race, color, religion or national origin)

Employment Experience

List below your last five employers beginning with present or most recent.

Please provide the months you worked, the name and address of your employer, rate of pay, and your position.
Please provide the months you worked, the name and address of your employer, rate of pay, and your position.
Please provide the months you worked, the name and address of your employer, rate of pay, and your position.
Please provide the months you worked, the name and address of your employer, rate of pay, and your position.
Please provide the months you worked, the name and address of your employer, rate of pay, and your position.

Applicant's Statement

I certify that answers given herein are true and complete to the best of my knowledge. In the event of employment, I understand that false or misleading information given in my application or interview(s) may result in withdrawal of an offer of employment, or if subsequent to employment, may result in dismissal.

I understand this employment application is not to be construed as a guarantee of employment. I further understand that, should I become employed, my employment with the organization does not constitute any form of contract, implied or expressed, and such employment may be terminated at will either by myself or my employer upon notice of one party to the other.

I authorize investigation of all statements contained in this application for employment as may be necessary in arriving at an employment decision. You may use this authority to check references with former employers I have listed, unless otherwise indicated, as well as the personal references listed.

Typing your name signifies that you have both read and agree to the statement above.

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