General Application Form

In case of an emergency, who should we contact?

RECENT EMPLOYER:

Previous Employer:

Applicant Certification

I understand that if driving is a requirement of the job for which I am applying, my employment is contingent upon having a valid driver’s license for the state in which I reside. I further understand that I must maintain a clean driving record and remain insurable under the company’s automobile liability policy as a condition of my employment. I understand that the company may now have, or may establish, a drug-free workplace or drug and/or alcohol testing program consistent with applicable federal, state and local law. If the company has such a program and I am offered a conditional offer of employment, I understand that if a pre-employment (post-offer) drug and/or alcohol test is positive, the employment offer may be withdrawn. I agree to work under the conditions requiring a drug-free workplace, consistent with applicable federal, state and local law. I also understand that all employees in the location, pursuant to the company’s policy may be subject to urinalysis and/or blood screening or other medically recognized tests designed to detect the presence of alcohol or illegal or control drugs. If employed, I understand that the taking of alcohol and/or drug tests is a condition of continual employment and I agree to undergo alcohol and drug testing consistent with the company’s policies and applicable federal, state and local law. If employed by the company, I understand and agree that the company, to the extent permitted by federal, state and local law, may exercise its right, without prior warning or notice to conduct investigations of property (including, but not limited to, files lockers, desks, vehicles and computers) and, in certain circumstances, my personal property. I understand and agree that as a condition of employment and to the extent permitted by federal, state and local law, I may be required to sign a confidentiality, restrictive covenant, and/or conflict of interest agreement. I certify that all the information on this application, my resume, or any supporting documents, I may present during any interview is and will be complete and accurate to the best of my knowledge. I understand that any falsification, misrepresentation, or omission of any information may result in disqualification from consideration for employment or, if employed, disciplinary action, up to and include immediate dismissal. If employed by the company, I authorize the use of my name and likeness, in whole or in part in the use of commercial materials at the discretion of the company and agree that I shall not be entitled to any compensation or injunctive relief of any type. I hereby waive any right of inspection or approval of the finished product. I further waive the return or any materials, including but not limited to photographs, provided for the creation of said commercial materials. THIS COMPANY IS AN AT-WILL EMPLOYER AS ALLOWED BY APPLICABLE STATE LAW. THIS MEANS THAT REGARDLESS OF ANY PROVISION IN THIS APPLICATION, IF HIRED, THE COMPANY OR I MAY TERMINATE THIS EMPLOYMENT RELATIONSHIP AT ANY TIME, FOR ANY REASON, WITH OR WITHOUT CAUSE OR NOTICE. NO OFFICER, EMPLOYEE OR REPRESENTATIVE OF THE COMPANY IS AUTHORIZED TO ENTER INTO AN AGREEMENT, EXPRESSED OR IMPLIED, WITH ME OR ANY APPLICANT FOR EMPLOYMENT FOR A SPECIFIED PERIOD OF TIME UNLESS SUCH AN AGREEMENT IS PUT INTO A WRITTEN CONTRACT SIGNED BY AN OFFICER OF THE COMPANY. I authorize the company or its agents to confirm all statements contained in this application and/or resume as it relates to the position I am seeking to the extent permitted by federal, state or local law. I agree to complete any requisite authorization forms for the background investigation which may be permitted by federal, state or local law. If applicable and allow by law, I will receive a separate written notification regarding the company’s intent to obtain consumer reports.

I authorize and consent to, without reservation, any party or agency contact by this employer to furnish the above-mentioned information. I hereby release, discharge and hold harmless, to the extent permitted by federal, state and local law, any party delivering information to the Company or its duly authorized representative pursuant to this authorization from any liability, claims, charges, or cause of action which I may have as a result of the delivery or disclosure of the above requested information. I hereby release from liability the company and its representatives for seeking such information and all other persons, corporations, or organization furnishing such information. Further, if hired, I authorize the company to provide truthful information concerning my employment to future employers and hold the company harmless for providing such information. If hired by the company, I understand that I will be required to provide genuine documentation for establishing my identity and eligibility to be legally employed in the United States. I also understand this company employs only individuals who are legally eligible to work in the United States. IF HIRED, I AGREE TO CONFORM TO THE RULES AND REGULATIONS OF THE COMPANY AND UNDERSTAND THAT THE COMPANY HAS COMPLETE DISCRETION TO MODIFY SUCH RULES AND REGULATIONS AT ANY TIME, EXCEPT THAT IT WILL NOT MODIFY ITS POLICY OF EMPLOYMENT AT-WILL. I CERTIFY THAT ALL OF THE INFORMATION THAT I HAVE PROVIDED ON THIS APPLICATION IS TRUE, ACCURATE AND COMPLETE. SUBMITTING FALSE INFORMATION MAY RESULT IN TERMINATION OR LOSS OF BENEFITS. DO NOT SIGN UNTIL YOU HAVE READ ALL OF THE INFORMATION CONTAINED IN THIS APPLICATION.