EMPLOYMENT APPLICATION

ALL POTENTIAL EMPLOYEES ARE EVALUATED WITHOUT REGARD TO RACE, COLOR, RELIGION, GENDER, NATIONAL ORIGIN, AGE, MARITAL OR VETERAN STATUS, THE PRESENCE OF A NON-JOB RELATED HANDICAP OR ANY OTHER LEGALLY PROTECTED STATUS.

Position Sought:
Location:
How did you learn about the position?
Your Name:
Your Address:
Your City:
Your State:
ZIP:
Home Phone:
Cell Phone:
Other Phone:
Drivers License # /State: /
Date Of Birth:
Email Address:
On what date would you be available for work?
Desired Wage/Salary
per
Are you a U.S. citizen, or are you otherwise authorized to work in the U.S. without any restriction? Yes No
Have you ever been convicted of a felony? Yes No
If yes, please describe circumstances:
Have you ever been involuntarily terminated or asked to resign from any position of employment? Yes No
If yes, please describe circumstances:
If selected for employment, are you willing to submit to a pre-employment drug screening test? Yes No

EDUCATION

School Name Location Years Attended Degree Received Major

Other training, Certifications, or Licenses held:
List other information pertinent to the employment you are seeking:


EMPLOYMENT

Employer Job Title Dates Employed Position Held Starting Salary
Ending Salary Duties Performed Reason for Leaving
$  $ 

Address
City
State
Zip
Phone
Supervisor Name

AVAILABILITY For New Position

  MONDAY TUESDAY WEDNESDAY THURSDAY FRIDAY SATURDAY SUNDAY
IN
OUT

Acknowledgment & Authorization
I certify that answers given herein are true and complete to the best of my knowledge.
I authorize investigation of all statements contained in this application for employment as may be necessary in arriving at an employment decision.
This application for employment shall be considered active for a period of time not to exceed 60days. Any applicant wishing to be considered for employment beyond this time period should inquire as to whether or not applications are being accepted at that time.
I hereby understand and acknowledge that I would be required to sign a "Commitment Contract" not exceeding a time period of 24 months, starting on the first day of employment. I also understand that in the event of employment, I will be "Bound by this Contract"
from leaving the organization and the position that I am being employed for, for the full term of the "Contract period" or as decided by
the Manager/Supervisor.
I hereby understand and acknowledge that, unless otherwise defined by applicable law, any employment relationship with this organization is of a "Contract Binding" nature, which means that the Employee may not resign until the "Contract Period" has elapsed and that the Employer may discharge Employee at any time with or without cause. It is further understood that this "Contract Binding" employment relationship may not be changed by any written document or by conduct unless such change is specifically acknowledged in writing by any authorized executive of this organization.
I also hereby acknowledge and understand that wages may be withheld and training costs may be assessed to me in the event of voluntary termination of employment within 6 months after completion of training.
In the event of employment, I understand that false or misleading information given in my application or interview(s) may result in discharge. I understand, also, that I am required to abide by all rules and regulations of the employer and agree to having received the "Job Responsibility Checklist" & "Sanitary procedures training" and take full responsibility in the event of any state authority issuing me a citation and or fines arising due to my negligent sanitary procedures.
I agree