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Personal History

The Company will attempt to reasonably accommodate an applicant’s religious needs, as required by law.

Skills and Qualifications


Work History

Please provide full and accurate details regarding all full-time and part-time work history. Do not omit any employer. You must complete this section even if you provide a resume.

Employment or Personal References

List three (3) Employment or Personal References – DO NOT LIST RELATIVES

List any relatives currently employed at the Company

We comply with all prohibitions on marital status discrimination as required under applicable state law.

Military Services

If applicable. Our Company’s policy will comply with the Uniformed Services Employment and Reemployment Rights Act (USERRA).

Resume/Cover Letter

If you have a resume or a cover letter, you may attach them here.


I certify that the information that I have provided to the Company as part of this application along with any resume or other material submitted by me for employment consideration is true, complete, and without omissions or misleading statements. I understand that my employment may be terminated because of false, misleading, or omitted information, regardless of the time that may have elapsed between furnishing the information and the discovery by the Company.

I authorize the Company to inquire into my education, professional and past employment history with references as needed to determine my qualifications and suitability for employment. I hereby give my consent to any former employer or educational institution to provide academic or employment related information about me to the Company. This includes any pertinent information they may have, personal or otherwise, and I release all parties from all liability for any damage that may result from furnishing this information.

I understand that I may be required to pass a pre-employment drug test and that my Social Security number must be validated. I further acknowledge that certain positions with the Company may also require a confirmation that I am licensed to drive a motor vehicle, and that my credit, civil and criminal records may be checked including a verification of my address. I consent freely and voluntarily to participate in the required drug test and background checks, and consent to the release of the results to the Company. I hereby release and hold harmless the Company from any liability whatsoever arising from the drug test and/or background checks and decisions concerning employment based upon the results of these tests and checks.

I understand that nothing in this employment application, the granting of an interview, or possible subsequent employment offer is intended to create an employment contract between the Company and myself. If hired, I will be an “Employee at Will” which means the Company may release me at any time for any reason with or without cause, and I am likewise free to leave at any time for any reason. I understand that no representative of the Company other than the President or Chief Executive Officer has any authority to enter into any agreement for employment that contradicts or modifies the foregoing in any manner, and any such agreement must be in writing and signed by the President or Chief Executive Officer.

If hired, I agree to conform to rules, regulations, and policies that the Company may periodically issue, withdraw, or modify. If hired, I understand that I will be required to keep my hair color within the range of “natural” colors (no blue, green, or other non-natural hair colors are allowed) and that facial piercings are not appropriate. I also understand that in order to comply with Company policy any visible tattoos may need to be covered appropriately during the workday, if hired. I agree to follow the Company grooming guidelines and to be dressed appropriately per the standards of the Company at all times in the workplace, if I am hired.

A photocopy, digital, and/or electronic copy of this signed authorization is as effective and binding as the original.