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> Employment Application <

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This application is not an employment contract but merely intended to evaluate suitability for employment. It is the policy of the company to provide equal employment to all qualified persons without discrimination on the basis of sex, race, color, religion, age, maritial status, national origin, citizenship, disability, veteran status, or any other status protected under state and federal law. It is also the policy of the company to have the option of conducting preemployment screening before a job offer is made, employment may be contingent upon successful completion of a medical examination, which may include providing body substance samples. This application will remain active for 30 days.

Personal Information

Please list below your current address and your two other most recent addresses:

EDUCATION

EMPLOYMENT HISTORY

Please list below your last three employers beginning with the most recent

JOB-RELATED SKILLS

Please answer all of the following questions if the position you are applying for requires driving a motor vehicle:

YES

PLEASE LIST ANY PROFESSIONAL LICENSES, DESIGNATIONS, CERTIFICATIONS, ETC. THAT MAY RELATE TO THE POSITION APPLIED FOR.

APPLICANT’S CERTIFICATION AGREEMENT

1) I authorize the investigation of all statements contained in this application and released from all liability any persons or employers supplying such information, and can also release the company from all liability that might result from making the investigation.

2) I certify that the facts and information set forth in this application are true and complete to the best of my knowledge. I understand that any falsification, misrepresentation, or omission of facts on this application (or on any required documents) will be cause for denial of employment or immediate termination of employment, regardless of when or how discovered.

3) I certify that the facts and information set forth in this application are true and complete to the best of my knowledge. I understand that any falsification, misrepresentation, or omission of facts on this application (or on any required documents) will be cause for denial of employment or immediate termination of employment, regardless of when or how discovered.

4) I agree, if I am offered and accept a position, to conform to all existing and future Company rules and regulations and I understand that the Company reserves the right to change wages, hours, ad working conditions as deemed necessary. I ALSO UNDERSTAND THAT, IF HIRED, MY EMPLOYMENT WILL BE AT-WILL, MEANING THAT EITHER PARTY CAN END THE EMPLOYMENT RELATIONSHIP AT ANY TIME AND FOR ANY OR NO REASON.

I have read and reviewed the information provided in this application and the above statements. By checking this box and typing my name below I certify that I understand all parts of it and have answered all questions completely and fully.

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