Application for Employment

Location you are interested in working at…

We consider applicants for all positions without regard to race, color, religion, sex, national origin, age, disability, veteran status or any other legally protected status.

How did you find out about this job?

Applicant Information

(Proof of U.S. citizenship or immigration status is required if hired.)

If yes, state the nature of the offense and disposition of the case. Include dates and places.

(NOTE: The existence of a criminal record does not constitute an automatic bar to employment)

Employment Information

Circle all shifts you are available to work

Education (circle highest level achieved)

Work History (please begin with most recent)

Dates of Employment:

Salary:

Dates of Employment:

Salary:

Dates of Employment:

Salary:

For references purposes:

If not, list the employers you do not wish us to contact and why

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 employment 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 form my dismissal from employment 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.

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 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 employment, 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.