Application For Employment Form (Page 3 of 3) in pdf

Authorizations & At-Will Employment Agreement

(please read carefully, then sign and date below)

I certify that I have personally completed this application. I declare that the information provided in this employ-

ment application is true and complete and I understand that any false information or significant omissions may

disqualify me from further consideration for employment and may be justification for my dismissal from employ-

ment if discovered at a later date. I agree to immediately notify this company if I should be convicted of a crime

while my job application is pending or during my employment, if hired.

I authorize this company to make an investigation of all information contained in this employment application

and I release from liability all companies and corporations supplying such information. I understand any false

answers, statements, or implications made by me on this application or other required documents shall be

considered sufficient cause for denial of employment or discharge.

I specifically authorize and direct my current and former employers to supply employment-related information to

this company and do hereby release my current and former employers from liability for providing information to

this company.

Upon termination of my employment for whatever reason, I release this company from all liability for supplying

any information concerning my employment to any potential employer.

I authorize this company, if applicable, to request a copy of my credit report, motor vehicle driving record, and

any other investigative report deemed necessary through various third party sources. As required by law, upon

request within a reasonable period of time, I will be notified as to the nature and scope of such investigations.

I hereby agree to submit to any drug test required of me, whether prior to my employment or if employed by this

company at any time thereafter. If requested, I will take a post-job offer physical examination and my employ-

ment, in the event I receive medical treatment for any condition, including a physical, psychological, emotional,

or psychiatric condition that is job-related, I hereby authorize the limited release and exchange of such medical

information relating to my condition between the treatment provider and a company-designated physician.

AT-WILL EMPLOYMENT AGREEMENT

I understand and agree that nothing contained in this application, or conveyed during any interview is intended

to create an employment contract between the company and me. In addition, I understand and agree that if you

employ me, in consideration of my employment, my employment and compensation will be at-will, for no

definite period of time, and may be terminated at any time, for any reason, or for no reason at all. I understand

that only the company’s President is authorized to change the employment-at-will status and such a change can

only be done in writing. I have read, understand, and agree to the above.

Signature _____________________________________________ Date __________________________

Name (please print) _____________________________________

Application For Employment Form Page 3