Employment Application

To be considered for employment, this Employment Application must be completed and signed personally by the applicant. Each question must be answered in full, even if a resume is provided. If an answer is NO or NOT APPLICABLE, indicate such.

We are an Equal Opportunity Employer. We consider all applications for all positions without regard to race, religion, creed, color, sex, age, national origin, disability, sexual orientation, marital or familial status, pregnancy, military status, veteran status, predisposing genetic characteristics or carrier status, arrest or conviction record, domestic violence victim status, or any other protected class or status. Applicants requiring a reasonable accommodation to participate in the application and/or interviewing process should notify an organization representative.

EMPLOYMENT HISTORY

LIST YOUR LAST THREE (3) EMPLOYERS INCLUDING MILITARY SERVICE STARTING WITH THE MOST RECENT.

Employer #1

Employer #2

Employer #3

SKILLS AND QUALIFICATIONS

EDUCATIONAL BACKGROUND

High School

College

REFERENCES

Reference #1

Reference #2

Reference #3

CONVICTION RECORD STATUS

All applicants and employees must, as a condition of employment, inform the organization of all convictions. This includes all convictions received within the past seven years, while your application for employment is pending, and within seven days of receiving a conviction if currently employed.

If you answered ‘yes’ and have been convicted of a felony or misdemeanor, please provide additional information below, such a s the crime(s), date(s), court location, sentencing information, disposition of sentence, and rehabilitation completed. Please note that a ‘yes’ answer to this question does not necessarily disqualify an applicant for employment. Rather, such factors as age and date of conviction, seriousness and nature of the crime as it relates to the job applied for, and rehabilitation will be considered. The organization reserves the right to reject individuals for employment based on job-related convictions.

Conviction #1

Conviction #2

PLEASE READ CAREFULLY AND SIGN BELOW

I hereby certify that all of the information I have provided on this Employment Application is true and correct to the best of my knowledge. I understand that any misrepresentation or omission of facts will disqualify me from further consideration of employment, withdrawal of any offer of employment, or, termination of employment, if already hired.

I authorize verification of all of the information I have provided on this Employment Application and understand that additional information may be needed to consider my application for employment. I authorize all previous employers, educational institutions, references, and other persons who have knowledge of me or my records to provide any and all information pertinent to my employment and release the same from any liability resulting from providing such information. I also release this organization and all of its employees from all liability for any damage that may result from reliance on the information furnished.

I understand that if employed, I agree to abide by all policies, procedures, rules, and regulations of the organization. I also understand and agree that, if hired, my employment is “at-will” and is for no definite period and may, regardless of the date of payment of my wages or salary, be terminated by myself or the organization at any time with or without cause or notice.