If you are under 18, and it is required,
can you furnish a work permit?

Are you legally eligible for
employment in this country?

Type of
employment
desired:

Are you able to meet the attendance
requirements of the position?

Have you been convicted of a
crime in the last seven (7) years?

Driver's license number if driving
is an essential job function

Skills and qualifications.

Summarize any training, skills, licenses, and/or certificates that may qualify you as being able to perform job-related functions in the position for which you are applying.

Did you graduate?

Did you graduate?

Did you graduate?

Course
of Study

Name

Years known

Name

Years known

Name

Years known

I understand that if I am employed, any misrepresentation or material omission made by me on this application will be sufficient cause for cancellation of this application or immediate discharge from the employer's service – whenever it is discovered.

I give the employer that right to contact and obtain information from all references, employers, educational institutuions and to otherwise verify the accuracy of the information contained in this application. I hereby release from liability the employer and its representatives for seeking, gathering and using such information and all other persons, corporations or organizations for furnishing such information.

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 local, state or federal law.

This application is current for only 60 days. At the conclusion of this time, if I have not heard from the employer and still wish to be considered fo employment, it will be necessary to fill out a new application.

If I am hired, I understand that I am free to resign at any time, with or without cause and without prior notice, and the employer reserves the same right to terminiate my employment at any time, with or without cause and without prior notice — except as may be required by law. This application does not constitute an agreement or contract for employment for any specified period or definite duration. I understand that no representative of the employer, other than an authorized officer has the authority to make any assurances to the contrary. I further understand that any such assurances must be in writing and signed by an authorized officer.

I understand it is the company's policy not to refuse to hire a qualified individual with a disability because of that person's need for a resonable accommodation as required by the ADA.

I also understand that if I am hired, I will be required to provide proof of identity and legal work authorization.

I understand it is the company's policy to require drug testing of all applicants. Any applicant who fails a drug test will not be considered for employment now or at any time in the future.

I understand that it is this company's policy that a drug test may be requested at any time during an employment period and that failure of a drug test guarantees immediate termination.

I further understand that my DMV record will be used as a consideration for employment and continued employment is subject to my updated DMV record.

I give the employer permission to access my DMV record at any time for use in determining my job eligibility.

I represent and warrant that I have read and fully understand the foregoing and seek employment under these conditions.

Applicant Name