Application For Employment (Page 3 of 3) in pdf

Page 3.

Personal References

List below three personal references (other than relatives) who have known you for the past five (5) or more years.

Name _________________________________________________________________________________________ (

)_________________

Address (Street, City, State, Zip)

Number of Years Acquainted

Occupation

Phone

Name _________________________________________________________________________________________ (

)_________________

Address (Street, City, State, Zip)

Number of Years Acquainted

Occupation

Phone

Name _________________________________________________________________________________________ (

)_________________

Address (Street, City, State, Zip)

Number of Years Acquainted

Occupation

Phone

“Notice to Applicants in Maryland: UNDER MARYLAND LAW, AN EMPLOYER MAY NOT REQUIRE OR DEMAND, AS A CONDITION

OF EMPLOYMENT, PROSPECTIVE EMPLOYMENT, OR CONTINUED EMPLOYMENT, THAT AN INDIVIDUAL SUBMIT TO OR

TAKE A LIE DETECTOR OR SIMILAR TEST. AN EMPLOYER WHO VIOLATES THIS LAW IS GUILTY OF A MISDEMEANOR AND

SUBJECT TO A FINE NOT EXCEEDING $100.”

“Notice to Applicants in Massachusetts: It is unlawful in Massachusetts to require or administer a lie detector test as a condition of employment or

continued employment. An employer who violates this law shall be subject to criminal penalties and civil liability.”

APPLICANT ACKNOWLEDGMENT (To be read and signed by all applicants)

I certify that this application was completed by me, and that all of the information in it is true and complete to the best of my knowledge. I understand that any misrepresentation of facts

or any false or misleading information provided by me in my application or during the interview process may result in the Company’s refusal to hire me, or if a conditional offer of

employment was already made, or already hired, may result in immediate termination of my employment. I also understand if a post hire drug test is positive I will be terminated.

I understand that any offer of employment is contingent upon successful completion of an authorized background check, and pre-employment drug and alcohol test. I understand that

the Company may contact any prior employer or company with which I previously contracted for the purposes of investigating my background. I authorize all persons, prior employers,

schools, companies, corporations, law enforcement agencies and credit bureaus to release any information concerning my background. I hereby release them from any and all claims

of liability in law and in equity that may arise out of furnishing such information to the Company or any authorized agent of the Company.

I understand that nothing in this application or any other Company document or communication (written or oral), or an acceptance of employment constitutes an employment contract

between the Company and me, and that should I be hired, my employment would be at will for no fixed duration, and could be terminated by the Company or by me at any time, with or

without cause or notice. I understand that no oral or written statement to the contrary shall change this relationship, or should be relied upon by me.

I agree to submit to any required drug / alcohol testing and/or physical examinations mandated by company policy and refusal may result in termination of employment.

I warrant that I am not party to a non-compete or confidentiality agreement and that there is no contractual, legal or otherwise restriction that will in any way interfere in your performing

your assigned position with the company.

I understand this application for employment shall be active for a period of time not to exceed 30 days, and if I wish to be considered for employment beyond this period, I must inquire

as to whether applications are being accepted at that time

__________________________

_____________________________________________________________________________________________________________

Date

Applicant’s Signature