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Application for Employment
Last Name:  First Name:  MI:
Address:  City:  State:
Have you been convicted of a crime within the last 7 years?
(Conviction will not necessarily disqualify applicant from employment.)
Yes No
If yes, please explain:
Are you lawfully entitled to be employed in the United States?Yes No
Are you at least 18 years of age?Yes No

Employment Desired
Position:     Date You Can Start:
Have you been employed by this Company before?    Yes No
If yes, when?     where?

Name and Address No. of
Years Attended
Did You
Subjects Studied
Elementary School:
High School:
Specialized Training:
Please answer the following questions if the position you are applying for requires driving a motor vehicle:
Do you have a valid driver's license?   Yes No
If yes, Driver's License Number:      State Issued:

Employment History
Employer 1:    Phone:
Date Started:   Date Ended:
Job Description:
Reason Left:

Employer 2:    Phone:
Date Started:   Date Ended:
Job Description:
Reason Left:

Employer 3:    Phone:
Date Started:   Date Ended:
Job Description:
Reason Left:

Applicant's Certification Agreement
1. I authorize the investigation of all statements contained in this application and release from all liability any persons or employers supplying such information, and I also release the company from all liability that might result from making the investigation.
2. I certify that the facts and information set forth in this application are true and complete to the best of my knowledge. I understand that any falsification, misrepresentation, or omission of facts on this application (or on any required documents) will be cause for denial of employment or immediate discipline, up to and including termination of employment, regardless of when or how discovered.
3. I agree, if I am offered and accept a position, to conform to all existing and future Company rules and regulations and I understand that the Company reserves the right to change policies, title, job description, wages, hours, and working conditions as deemed necessary. I ALSO UNDERSTAND THAT, IF HIRED, MY EMPLOYMENT WILL BE AT-WILL, MEANING THAT EITHER PARTY CAN END THE EMPLOYMENT RELATIONSHIP AT ANY TIME AND FOR ANY OR NO REASON, AND THAT ONLY A WRITTEN AGREEMENT BETWEEN THE PRESIDENT OF THE COMPANY AND ME, SIGNED BY BOTH OF US, CAN ALTER THE AT-WILL EMPLOYMENT RELATIONSHIP.
4. I understand that any employment offer is contingent upon my providing, within three (3) working days of employment, valid proof of identity and eligibility to work in order to comply with the Immigration Reform and Control Act of 1986.
5. I have read and reviewed the information provided in this application and the above statements. By signing this application for employment I certify that I understand all parts of it and have answered all questions completely and fully.

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