Applicant Information

Position(s) applied for/work desired

Date

Name

First Name

Last Name

Mailing Address

Address 1

Address 2

City

State / Province

ZIP / Postal Code

Email

Phone

Employment History

Employer Information

Please provide all employment information for your past four employers, starting with the most recent.

Other Skills & Qualifications

Summarize any job-related training, skills, licenses, certificates, and/or other qualifications.

Educational History

List school name and location, years completed, course of study, and any degrees earned.

High School

College

Technical Training

Other

References

Reference Information

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I understand that before an offer of employment can be made, I will be asked to authorize the potential employer to contact previous employers, educational institutions, and references, to obtain and verify the accuracy of information contained in this application. I hereby release from liability the potential employer and its representatives for seeking, gathering, and using such information to make employment decisions and all other persons or organizations for providing such information.

I understand that any misrepresentation or material omission made by me on this application will be sufficient cause for cancellation of this application or immediate termination of employment if I am employed, whenever it may be discovered.

If I am employed, I acknowledge that there is no specified length of employment and that this application does not constitute an agreement or contract for employment. Accordingly, either I or the employer can terminate the relationship at will, with or without cause, at any time, so long as there is no violation of applicable federal or state law.

I understand that it is the policy of this organization not to refuse to hire or otherwise discriminate against a qualified individual with a disability because of that person's need for a reasonable accommodation as required by the ADA. If I need an accommodation, I will notify the employer before I accept an offer, or as soon as possible after the need arises.

I understand that if I am employed, I will be required to provide satisfactory proof of identity and legal work authorization within three days of being hired. Failure to submit such proof within the required time shall result in immediate termination of employment.

I understand that a condition of employment may be passing a pre-employment drug screen and background check. A positive drug screen will disqualify me from positions where safety is a concern, or where driving is required, a poor driving record will disqualify me from positions where driving is required, and criminal convictions may disqualify me from positions where I may be granted access to security-sensitive work sites or information.

I represent and warrant that I have read and fully understand the foregoing, and that I seek employment under these conditions.

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