Please list any other skills, licenses or certificates that may be job related or that you feel would be a value to this job or company.
Reason for leaving or are you currently employed?:
Applicant Note
This application is intended for use in evaluating your qualifications for employment. This is not an employment contract. Please answer all appropriate questions completely and accurately. False or misleading statements during the interview and on this form are grounds for terminating the applicant process, or if discovered after employment, terminating employment. All qualified applicants will receive consideration without discrimination because of sex, marital status, race, age, color, religion, national origin, the presence of disabilities, or any other legally protected status. Additional testing of job-related skills and for the presence of drugs in your body may be required prior to employment.
All offers are also contingent upon background screening.
Certification and Release
I certify that I have read and understand the applicant note on page one of this form and that the answers given by the forgoing question and the statements made by me are complete and true to the best of my knowledge and belief. I understand that any false information, omissions or misrepresentations of facts called for in this application may result in rejection of my application or discharge at any time during my employment.
I authorize the company and/or its agents, including consumer reporting bureaus, to verify any of this information including, but not limited to, criminal history and motor vehicle driving records. I authorize all persons, schools, companies and law enforcement authorities to release any information concerning my background and hereby release any said persons, schools, companies and law enforcement authorities from any liability or any damages whatsoever for issuing information.
I also understand that the use of illegal drugs is prohibited during employment. If company policy requires, I am willing to submit to drug tests to detect the use of illegal drugs prior to and during employment.
I understand that I am responsible for being familiar with the Company’s policies, rules and regulations, and I understand that the Company has complete discretion to modify its policies, rules, regulations and practices at any time, to the extent permitted by the federal, state and local law, except that it will not modify its policy of employment at will. By my continued employment with the Company, I consent to any such changes.
I agree to submit to binding arbitration all disputes and claims arising out of the submission of this application. I further agree, in the event that I am hired by the Company, that all disputes that cannot be resolved by informal internal resolution which might arise out of my employment with the Company, whether during or after that employment, will be submitted to binding arbitration. I agree that such arbitration shall be conducted under the rules of the American Arbitration Association.
I understand that employment with this Company is “at will” which means that either I or the Company can terminate the employment relationship at any time, with or without prior notice, and for any reason not prohibited by the statute. All employment is continued on that basis. I understand that no supervisor, manager, or executive of the Company, other than the President, has any authority to alter the forgoing.
I also understand that if I am employed, I will be required to provide satisfactory proof of identity and legal work authorization within three days of being hired. Failure to submit such proof within the required time shall result in immediate termination of employment.
Should a search of public records (including records documenting an arrest, indictment, conviction, civil judicial action, tax lien or outstanding judgment) be conducted by internal personnel employed by the Company, I am entitled to copies of any such public records obtained by the Company unless I make a check by the statement below. If I am not hired as a result of such information, I am entitled to a copy of any such records even though I have checked the statement below.
I waive the receipt of a copy of any public record described in the paragraph above
