“AT-WILL” EMPLOYMENT APPLICATION Thank you for applying! THIS APPLICATION IS NOT AN EMPLOYMENT CONTRACT but merely is 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 race, color, religion, national origin or ancestry, sex, age, disability, veteran status, genetic information, or any other legally protected status under local, state, or federal law. This application will remain active for 180 days. By completing and submitting the form below:1)I authorize the investigation of all statements contained in this application and release from all liability any persons or employers supplying such information, and I also release the company from all liability that might result from making the investigation.2)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 discipline, up to and including termination of employment, regardless of when or how discovered.3)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 policies, title, job description, wages, hours and 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, AND THAT ONLY A WRITTEN AGREEMENT BETWEEN THE PRESIDENT OF THE COMPANY AND ME, SIGNED BY BOTH OF US, CAN ALTER THE “AT-WILL” EMPLOYMENT RELATIONSHIP. CONVERSELY, I MAY RESIGN AT ANY TIME.4)I understand that any employment offer is contingent upon my providing, within three (3) working days of employment, valid proof of identity and eligibility to work in order to comply with the Immigration Reform and Control Act of 1986.5)I have read and reviewed the information provided in this application and the above statements. By submitting this application for employment I certify that I understand all parts of it and have answered all questions completely and fully. First & Last Name Current Address, Town, State & Zip Code Previous Address, Town, State & Zip Code 2nd Previous Address, Town, State & Zip Code Email Address Cell/Home Phone Most Recent School Attended School location, City/State Did you earn a Diploma? Position Applied For: Date You Can Start Desired Salary: $ Do You Prefer: Do You Prefer: Full Time Part Time Either Can you work: Can you work: Weekends Evenings Days Nights Are you at least 18 years of age and eligible for work in the USA? Are you at least 18 years of age and eligible for work in the USA? Yes No Will you work overtime when necessary? Will you work overtime when necessary? Yes No Are you on Layoff & subject to recall? Are you on Layoff & subject to recall? Yes No Are you currently bound by a noncompetition or trade secret agreement? Are you currently bound by a noncompetition or trade secret agreement? Yes No If yes, please explain: Have you ever been discharged, asked to resign, or given the option to resign from a job? Have you ever been discharged, asked to resign, or given the option to resign from a job? Yes No If yes, please explain. Have you ever been convicted of, pled guilty or no contest to any crime? Have you ever been convicted of, pled guilty or no contest to any crime? Yes No If yes, please explain. (A "yes" answer does not necessarily disqualify you from employment.) May we contact your present employer? May we contact your present employer? Yes No Most recent employer: Position held: Dates From/To: Pay rate upon leaving: Name of Supervisor: Duties: Reason for leaving: Most recent employer: Position held: Dates From/To: Pay rate upon leaving: Name of Supervisor: Duties: Reason for leaving: 11 + 15 = Submit
