Date of Application*
Social Security Number
Position Applied For*
Date You Can Start*
Are You Currently Employed?*
May We Contact Your Current Employer?*
Are you 18 Years or Older?*
Have You Ever Applied With Us Before?*
What Days Are You Available?*
Have you been convicted of a felony within the last ten years?*YesNo
Are you prevented from lawfully becoming employed in this country because of Visa or Immigration Status?*YesNo
Describe Experience With Prior Training or Applicable Skills
U. S. Military or Naval Services
“I certify that the facts contained in this application are true and cpmplete to the best of my knowledge and understand that, if employed, falsified statements on this application shall be grounds for dismissal.
I authorize investigation of all statements contained herein and the references and employers listed above to give you any and all information concerning my previous employment and any pertinent information they may have, personal or otherwise, and release the company from all liability for any damage that may result from utilization of such information.
I also understand and agree that no representative of the company has any authority to enter into any agreement for employment for any specified period of time, or to make any agreement contrary to the foregoing, unless it is in writing and signed by an authorized company representative.
This waiver does not permit the release or use of disability-related or medical information in a manner prohibited by the Americans with Disabilities Act (ADA) and other relevant federal and state laws.”