Application For Employment Form (Page 4 of 4) in pdf

NOTICE TO APPLICANTS: This employer complies with the Americans with Disabilities Act of 1990. During the interview

process, you may be asked questions concerning your ability to perform job-related functions. If you are given a conditional

offer of employment, you may be required to complete a post-job offer medical history questionnaire and/or undergo a

medical examination. If required, all entering employees in the same job category will be subject to the same medical

questionnaire and/or examination and all information will be kept confidential and in separate files.

APPLICANT’S STATEMENT

I certify that the answers given herein are true and complete to the best of my knowledge. I authorize the investigation of all

matters contained in this application and hereby give the Employer permission to contact schools, previous employers,

references, and others, and hereby release the employer from any liability as a result of such contact. I understand that

misrepresentation, omissions of facts or incomplete information requested in this application may remove me from further

consideration for employment. In addition, if employed, any misrepresentations or omissions of facts called for in this

application will be cause for dismissal at any time without any previous notice.

Applicants accepted for employment should clearly understand that while we make every effort to provide steady, continuous

work, we have no employment contracts, and we cannot guarantee the permanence of any position. Job tenure can be

affected by many factors including business/economic conditions, changes in laws or employee policies, conformity to our

work rules, job performance, etc. And of course, an employee may elect to leave on their own accord to seek other jobs.

I understand that my employment with the Employer is for no specific term and may be terminated by me or the Employer

with or without notice or cause at any time. I further understand that no oral promise, employer policy, custom, business

practice or other procedure (including the Employer’s Personnel Handbook or any personnel manuals) constitutes an

employment contract or modification of the at-will employment relationship between me and the Employer.

The contents of any employee handbook or personnel manuals, as well as other Employer policies and practices, are

subject to change or modification by the Employer, solely at its discretion, without notice. I also understand that no

supervisor or other official of the Employer (except its Chief Executive Officer, in writing) has the authority to enter into any

agreement with me or to make any agreement contrary to the foregoing.

We conduct our business with the highest possible degree of safety and efficiency. Because of this, the Employer may

require applicants for employment to undergo blood and/or urinalysis screening for drug or alcohol use as part of our pre-

placement physical examination. In addition, all employees of the Employer are subject to blood tests or urinalysis screening

for drug or alcohol use.

This application will remain for ninety (90) days. Any applicant wishing to be considered for employment beyond ninety (90)

days should reapply.

I agree in advance if there is a workmens’ compensation or health claim, I the undersigned agree to an illegal substance and

alcohol testing and understand that if I test positive my benefits, if any, will be severely cut or none at all.

Signature ____________________________________________________________ Date _________________________

This employer is an equal employment opportunity employer.

We adhere to a policy of making employment decisions

without regard to race, color, age, sex, religion, national origin, handicap or marital status. We assure you that your

opportunity for employment with this Employer depends solely upon your qualifications.

Application For Employment Form Page 4