Application for Employment

Step 1 of 5

ADDITIONAL SPACE

Please use the space below to continue responses from pages 1 through 3. If you need more space, attach a separate sheet to this application. Please print and sign your name on the sheet, and include your social security number.

CERTIFICATION AND AGREEMENT
READ CAREFULLY BEFORE SIGNING
I UNDERSTAND AND AGREE THAT:
1. Any misrepresentation or omission of facts in my application or any attachments to my application (including any resumes) may result in refusal of employment or if employed, termination from employment.
2. If I am offered and accept employment, I understand and agree that any person authorized by the Company can at any time request that I submit to a search of my person, purses, and packages in my possession, or any locker, desk, computer, phone or files that may be assigned to me. I understand that my refusal to submit to such a search may result in termination. I hereby waive all claims for damages resulting from such examination.
3. I understand and agree that I may be required to take a pre-employment blood, urine, hair and/or other test to determine if I am currently using illegal drugs. If I am offered and accept employment, I further understand that I may be required to take a blood, urine, hair and/or other test to determine if I am under the influence of alcohol, impaired by drugs or other intoxicants, and/or have illegal drugs in my system. I also understand that, depending on the particular job position, I may be required to submit to a medical examination or inquiry after a conditional offer of employment, but prior to starting work. If I am employed by the Company, I understand that I may be required to submit to a medical examination or inquiry to determine my ability to perform the essential functions of my job, whether I am entitled to a reasonable accommodation and/or whether I pose a direct threat to myself or others. The tests, exams and inquiries discussed above, to the extent that they are to be performed by someone other than my personal physician, are at the Company’s expense. I authorize any physician, including my personal physician, to release any information to the Company related to any such test, examination or inquiry and I agree to execute any necessary releases and authorizations for the Company to obtain such information. Failure to submit to such testing and/or provide the necessary releases and authorizations may result in the refusal of employment, including the withdrawal of an offer of employment, or, if employed, disciplinary action up to and including termination.
4. If I am offered and accept employment, I further understand that the Company can, except as otherwise provided by law, change wages, benefits and/or working conditions in its sole discretion, and that I may be required to work overtime or on weekends, depending upon job requirements.
5. I UNDERSTAND THAT THE COMPANY MAY, FROM TIME TO TIME, ESTABLISH RULES, REGULATIONS, POLICIES AND/OR DISCIPLINARY PROCEDURES, SOME OF WHICH MAY BE REDUCED TO WRITING. IN CONSIDERATION OF POSSIBLE MY EMPLOYMENT, I AGREE, IF HIRED, TO CONFORM TO ALL APPLICABLE RULES, REGULATIONS, POLICIES, AND/OR DISCIPLINARY PROCEDURES OF THE COMPANY AND/OR ANY DEPARTMENT THEREOF. I UNDERSTAND THAT THOSE RULES, REGULATIONS, POLICIES AND/OR DISCIPLINARY PROCEDURES ARE NOT INTENDED BY THE COMPANY TO CREATE AN OBLIGATION OF CONTINUED EMPLOYMENT.
6. I UNDERSTAND THAT THIS DOCUMENT IS AN APPLICATION FOR EMPLOYMENT AND CONTINUED EMPLOYMENT IS NOT BEING OFFERED. I UNDERSTAND AND AGREE THAT MY EMPLOYMENT, BOTH DURING AND AFTER ANY INTRODUCTORY OR ORIENTATION PERIOD, IS FOR AN INDEFINITE PERIOD, AND THAT NOTHING IN THIS APPLICATION SHALL BE DEEMED TO CREATE ANY CONTRACT OF CONTINUED EMPLOYMENT BETWEEN ME AND THE COMPANY. I FURTHER UNDERSTAND THAT MY EMPLOYMENT CAN BE TERMINATED AT WILL AT ANY TIME BY MYSELF OR THE COMPANY WITH OR WITHOUT CAUSE. I UNDERSTAND THAT EMPLOYMENT BEYOND ANY INTRODUCTORY OR ORIENTATION PERIOD OR EMPLOYMENT FOR A NUMBER OF YEARS SHALL NOT RESULT IN ANY HEIGHTENED EXPECTATION OF CONTINUED EMPLOYMENT. I UNDERSTAND AND AGREE THAT ANY STATEMENTS TO THE CONTRARY, WHETHER ORAL OR WRITTEN, ARE EXPRESSLY DISAVOWED AND ARE NOT TO BE RELIED UPON BY ME. I FURTHER UNDERSTAND THAT NO REPRESENTATIVE OF THE COMPANY HAS ANY AUTHORITY TO ENTER INTO AN AGREEMENT FOR EMPLOYMENT FOR ANY SPECIFIED PERIOD OF TIME OR TO MAKE ANY AGREEMENT CONTRARY TO THE FOREGOING EXCEPT IN A WRITTEN DOCUMENT SIGNED BY THE PRESIDENT OF THE COMPANY.
7. It is my understanding that this application for employment will only remain active for thirty (30) days following the date of application.
Untitled*
- I accept
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APPLICATION FOR EMPLOYMENT

Step 1 of 5

WE ARE AN EQUAL OPPORTUNITY EMPLOYER

EDUCATION:

Indicate any foreign languages you can speak, read and/or write

References

EMPLOYMENT EXPERIENCE

ADDITIONAL SPACE

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