Job Application - Apply Online

Please complete all questions on this application even if you have already submitted a resume. PLEASE DO NOT ANSWER “SEE ATTACHED RESUME” TO ANY QUESTIONS. This application is our primary pre-employment form. We are an Equal Opportunity Employer. Applicants will be considered without discrimination because of race, religion, color, sex, age, national origin, martial status, handicap or veteran’s status. Required Fields are Bolded

(This application will be kept on file in our office for 90 days from this date)

Name:
Telephone:
Have you ever worked for this company under a different name?
Is any additional information relative to change of name, use of an assumed name or nickname necessary to enable a check on your work record? If yes, please explain:

Address:
City:
State:
Zip:
Email Address:

Applicants must be 18 years of age before the date of hire.
Name of any relatives, other than spouse, already employed by us:
Type of position you are applying for: (Please check one)
Clerical Sales Technical Customer Service Other
Are you eligible for employment?

If you are applying for either Clerical, Sales, or Customer Service position please describe your computer experience in detail.


Have you ever been convicted of a crime?
If so, state the nature of the offense and the date the offense took place:
(Conviction of a crime will not necessarily be a bar to employment. Factors such as age and time of the offense, seriousness and nature of the violation, and rehabilitation and applicability to job description will be taken into account).

When will you be available to begin work?
Are you on lay-off subject to recall somewhere else?

Are you able and willing to perform job related functions? If no, please explain:

How many days were you absent from work during the past year?
Were you a member of the U.S. Armed Forces? If yes, state your MOS, branch and duties:

Please list all schools attended:
Name:
Dates Attended:
Degree:

Name:
Dates Attended:
Degree:

Name:
Dates Attended:
Degree:

Please list your last three jobs, dates of employment, and names of Supervisors to be contacts for references:
Place Employment:
Telephone Number:
Date of Employment:
Name of Supervisor:

Place Employment:
Telephone Number:
Date of Employment:
Name of Supervisor:

Place Employment:
Telephone Number:
Date of Employment:
Name of Supervisor:

The facts set forth in my application are true and complete. I authorize the Company to investigate all statements contained in this application, and hereby authorize my former employers to furnish all information pertaining to my work record. I hereby release my former employers from any and all liability on account of furnishing such information to the Company. I understand that if employed, false statements, omissions, or misleading statements on this publication shall be considered sufficient cause for dismissal. I agree that the Company shall not be held liable in any respect if my employment is terminated because of such omissions, or false or misleading statements. The Company is hereby authorized to investigate my employment history, including the contacting of employers listed above (if there is a particular employer you do not wish us to contact please indicate which one and why?) I affirm under penalty of perjury that all statements made on this application are true. I understand that all statements made by me in connection with this application for employment are subject to investigation and verification which may include checking any and all public records to verify the accuracy of information provided. The company reserves the right to do drug testing prior to employment. An omission, material misstatement or fraudulent representation may disqualify me from appointment and/or lead to revocation of my appointment.


I understand and agree that if employed I will be subject to 180 day probation period. I also understand that if employed my employment will be for no definite period and may be terminated by either the company or myself at any time without previous notice and either any written or oral statement made by any managerial or supervisory official of the company shall be construed to establish any contractual relationship between the company (including any related company, any parent, subsidiary, or successor company and myself).

"By signing this application I agree to any background check and validity of my statements."

Signature of Applicant: