Application For Employment (Page 2 of 2) in pdf

LIST BELOW ALL PRESENT AND PAST EMPLOYMENT BEGINNING WITH MOST RECENT.

Name & Address of Company (Describe business type)

Dates Employed

_____________________________________________________From _________________To________________

_____________________________________________________Job Title _________________________________

Phone _______________________________________________ Compensation_____________________________

Supervisor's Name _____________________________________ Start______________________ Last___________

Reason Left ____________________________________________________________________________________

Duties_________________________________________________________________________________________

Name & Address of Company (Describe business type)

Dates Employed

_____________________________________________________From _________________To________________

_____________________________________________________Job Title _________________________________

Phone _______________________________________________ Compensation_____________________________

Supervisor's Name _____________________________________ Start______________________ Last___________

Reason Left ____________________________________________________________________________________

Duties_________________________________________________________________________________________

Name & Address of Company (Describe business type)

Dates Employed

_____________________________________________________From _________________To________________

_____________________________________________________Job Title _________________________________

Phone _______________________________________________ Compensation_____________________________

Supervisor's Name _____________________________________ Start______________________ Last___________

Reason Left ____________________________________________________________________________________

Duties_________________________________________________________________________________________

I certify that all the information on this application, my resume, or any supporting documents is correct, and I understand that any

misrepresentation or omission of any information will result in disqualification from consideration for employment or, if employed, my

termination.

I understand that this application is not a contract, offer or promise of employment. If hired, I will be able to resign at any time for any

reason. Likewise, the Company can terminate my employment at any time, with or without any reason.

I authorize the Company or its agents to investigate all statements contained in this application and/or resume. I further understand

that a credit and background check may be made including, but not limited to, consumer credit history, criminal history, driving record,

employment, military, education and general public records which will provide information concerning my character and general

reputation. I hereby authorize my former employers, educational institutions or other reference providers to furnish all information

pertaining to my work or educational record. I release my former employers, educational institutions, supervisors, and references from

all liability on account of furnishing information to this company or its agents.

Should I wish to obtain a copy of the consumer credit history report if made, it will be provided upon written request. I hereby release

from liability the Company and its representative for seeking such information and all other persons, corporations or organizations for

furnishing such information.

I understand that, as a condition of employment I may be required to sign a non-compete agreement, a conflict of interest statement,

and/or an arbitration agreement and I hereby agree to arbitrate all disputes regarding my application for employment and any

employment related matters rather than resolving them in court or other forum. I understand that the Company may now have, or may

establish, a drug-free workplace or a post-accident drug-testing program. If it has one now and I am offered a conditional offer of

employment I agree to work under the conditions requiring a drug-free workplace. I also understand that all employees of the location

may be subject to urinalysis and/or blood screening or other medically recognized tests designed to detect the presence of alcohol or

controlled drugs. lf detected, the offer of employment will be withdrawn. If employed, I understand that the taking of alcohol and/or

drug tests is a condition of continual employment and I agree to undergo random, fitness for duty, return to work and reasonable

suspicion alcohol and drug testing. Refusal to take such tests when asked may result in termination.

This application is current for only sixty (60) days. At the conclusion of this time, if you have not heard from the Company and still

wish to be considered for employment it will be necessary for you to complete a new application.

Applicant Signature________________________________________________________ Date ____________________________

Application For Employment Page 2

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