Online Employment Application

APPLICATION FOR EMPLOYMENT

Federal and State laws prohibit discrimination in employment because of sex, age, race, color, religion, creed, national origin, ancestry, citizenship, marital status, veteran status, physical or mental disability, sexual orientation, pregnancy or mental condition.

Name:

Soc. Sec.#:

Address:

Phone:

Position:

Shift:

1st 2nd

EMPLOYMENT RECORD - PAST TEN YEARS (Please list most recent employer first.)
Previous Employer 1	Employment Details: Employed from:____ To:_____ Company Name:_________________ Address/Phone________________________ Supervisor__________ Duties/Responsibilities_________________________________ ________________________________________________________ ________________________________________________________ ________________________________________________________ Position First Held:_____________ Position When Left
Previous Employer 2	Employment Details: Employed from:____ To:_____ Company Name:_________________ Address/Phone________________________ Supervisor__________ Duties/Responsibilities_________________________________ ________________________________________________________ ________________________________________________________ ________________________________________________________ Position First Held:_____________ Position When Left
Previous Employer 3	Employment Details: Employed from:____ To:_____ Company Name:_________________ Address/Phone________________________ Supervisor__________ Duties/Responsibilities_________________________________ ________________________________________________________ ________________________________________________________ ________________________________________________________ Position First Held:_____________ Position When Left

Applicant's Statement

I acknowledge and understand that if employed, despite any company disciplinary procedure, rules, standards of conductor regulations, my employment would be "at will" which means "the relationship between employer and the employee may be terminated by either party unilaterally at any time, with or without notice, for any reason, or for no reason at all." Further, I understand that the company can demote, transfer, suspend or otherwise discipline an employee in its sole and absolute discretion and that there is no promise nor representation of continued employment, or for continued or indefinite employment at a specific position or rate of pay. I further understand that only the President of the company has any authority to enter into any agreement contrary to the above "Terms of Employment" and such an agreement would have to be in writing and signed by the President.

I also certify that information contained in this application is accurate to the best of my knowledge. I understand that if employed, omissions of fact will be cause for termination of employment. I authorize current or prior employers, schools or persons listed in this application to give this company or its agents any and all information concerning my previous employment and I release all parties from all liability for any damage that may result for furnishing the same to this company or its agents.

I also understand that all offers of employment are conditioned on my providing satisfactory proof of my identity and legal authority to work in the United States as required by the Immigration Reform and Control Act.

The completion of this application does not constitute any guaranty of employment.

I agree to these terms, submit my application.