Employment Application Form (Page 2 of 3) in pdf

EDUCATION AND TRAINING

Name

City/State

Major/Degree

Graduate

High School ______________________________________________________________________Y__N__

Community

College, Trade

School___________________________________________________________________________ Y__N__

College __________________________________________________________________________ Y__N__

Training Programs __________________________________________________________________Y__N__

Working knowledge of any software? __Yes __No If yes, please specify____________________________

Special Skills, training, experience, or qualifications related to the position you are applying for:____________

_________________________________________________________________________________________

Languages that you speak, read, or write:________________________________________________________

EMPLOYMENT HISTORY

Job

From

Reason For

Employer

______

Title

Address

Mo/Yr

__Supervisor

_____ Leaving__

_________________________________________________________________________________________

PLEASE READ CAREFULLY BEFORE SUBMITTING THIS APPLICATION

The foregoing is an accurate statement of the facts to the best of my knowledge. I understand that any falsification, incomplete information or

misrepresentation may be reason to refuse me employment or cause disciplinary action, including termination of employment, if hired and discovered

later. I also understand that all offers of employment are conditioned upon my passing a drug test specified by the Company, providing satisfactory

proof of my identity and legal eligibility to work in the United States, and on satisfactory completion of an employment background check.

I understand and agree that my employment is at-will, that nothing in this application or in any other express or implied agreement shall be deemed to

create or become part of any contract of employment for a specified term between me and the Peppermill Rainbow Club (Company) and that my

employment can be terminated at any time by me or the company for any or no cause. I understand and agree that any statements to the contrary

whether oral or written are expressly disavowed and are not to be relied upon by me. I understand that no representative of this Company, other than

the President, has any authority to enter into any agreement for employment for any specified period of time or to make any agreement contrary to

the foregoing. Further, the President may not alter the at-will nature of the employment relationship unless it is done in a specific written employment

agreement for a fixed term.

I hereby authorize the company to investigate my record which may include verification of information with federal, state, and local authorities. I

also authorize my present and former employers, school officials, and any persons I name as references to give information regarding me, whether or

not it is on its records. I hereby release the Company and its representatives from liability for seeking such information and all other persons,

corporations or organizations from furnishing such information. I also authorize the Company to give information concerning me, whether or not it is

on its records, to prospective employers in the future, and release the Company and its employees from any liability whatsoever.

I understand that I may be to take a pre-employment drug test, and I may also be required to undergo random drug testing and/or drug testing for

reasonable suspicion of drug use. I further understand that I will be subject to discipline, up to and including termination, if I fail to pass any drug test

or if I refuse to take any drug test.

Employment Application Form Page 2

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