* Required Information
Employment Application
Date Available to Work:
From
To
Hours Available to Work:
From
To
Additional Date & Time

if no, describe the functions that cannot be performed:

If you are able to perform the functions of the job only with accomodations, please describe the nature of the accommodations you required and how you would perform the functions:

Note: We comply with the ADA and consider readonable accomodation measured that may be necessary for eligible applicants/employees to perform essential functions. Hire may be subject to passing a medical examination, and to skill and agility tests.

Employment History

List below all present and past employment starting with your most recent employer (last four is sufficient). Account for all
periods of unemployment. Please give accurate and complete information, including seld-employment, part-time work, and
military employment. You may include any work performed on a volunteer basis.

Additional Employment History
Education
Additional Education
Professional references (No relatives or former employers)
Additional Reference
Skills and Qualifications

Please list any special skills, experiences, and qualifications which you feel would enhance
your ability to perform the job for which you are applying

How were you referred to our company?

Please read carefully, initial each paragraph and sign below
Initials
* I hereby certify that l have not knowingly withheld any information that might adversely affect my chances for employment and that the answers given by me are true and correct to the best of my knowledge. I further certify that I, the undersigned applicant. have personally completed this application. l understand that any omission or misstatement of material fact on this application or on any document used to secure employment shall be grounds for rejection of this application or for immediate discharge if l am employed. regardless of the time elapsed before discovery.
Initials
* I hereby authorize to thoroughly investigate my references. academic information and employment history. and l authorize the schools. prior employers and references I have listed to disclose to the company any and all letters. reports and other information related to my school or work records. without giving me prior notice of such disclosure. In addition. I hereby release the Company. my former employers and all other persons. corporations. partnerships and associations from any and all claims. demands or liabilities arising out of or In any way related to such investigation or disclosure.
Initials
* I understand that nothing contained in the application. or conveyed during any interview which may be granted or during my employment. if hired. is intended to create an employment contract between me and the Company. other than an at-will relationship. In addition. I understand and agree that it I am employed. my employment is terminated at -will by the Company. and that no promises or representations contrary to the foregoing are binding on the company unless made in writing and signed by me and the Company's President/CEO. Further. in consideration of my employment. I agree to conform to the rules and standards of the Company and agree that my employment is at will and that it may be terminated by the Company or me at any time. with or without notice or cause.
Initials
* Should a search of public records (including records documenting an arrest. indictment. conviction. civil judicial action. tax lien or outstanding judgement) be conducted by internal personnel employed by the Company. I am entitled to copies of any such public records obtained by the Company unless I mark the check box below. If I am not hired or discharged as a result of such information. I am entitled to a copy of any such records even though I have checked the box below.
Initials
* I have no objection to taking a physical/medical examination at any time at the option and expense of the Company. I understand that applicants must pass a drug screening urinalysis before employment, and I consent to such procedure, at company expense. If I am a minor, I agree to obtain parental consent for the drug screening
Initials
* I understand that. if I am offered employment. I will be required to review. complete and execute various employment documents including. but not limited to, this application, employee handbook and forms showing I received certain material. I agree the process of my being hired will not be complete until all such documents required by the Company have been signed
Initials
* I understand that. if I am offered employment. I will be required to review. complete and execute various employment documents including, but not limited to this application. employee handbook and forms showing I received certain material. I agree the process of my being hired will not be complete until all such documents required by the Company have been signed

Company Problem Resolution Procedure and Agreement to Arbitrate

Initials
* If offered employment. I understand that a condition of employment is to agree to the company's problem resolution procedure,which includes an agreement to arbitrate as a final and binding step. and I agree that the process of my becoming an employee can not and will not become complete until I have signed all employment documents including. but not limited to, the Agreement to Arbitrate.
CANCEL