* Are you legally eligible to be employed in the United States? (Proof of identity and eligibility will be required upon employment):

Yes   No

* Are you at least 18 years or older? (If no, you may be required to provide authorization to work):

Yes   No

* Have you ever worked for this Company before?:

Yes   No

If Yes, please provide details (Where/When/Job Title):

* When would you be available to begin work?:

* Type of employment desired:

Full-Time Part Time Seasonal

* Are you currently employed?:

Yes   No

If so may we inquire of your present employer?:

Yes   No

If presently employed, why are you considering leaving?:

Give record of all High Schools, Colleges, Universities and Vocational/Technical Schools you have attended.

School Name & Location	Did you Graduate?	Degree Received	Subjects Studied/Major
*	* Yes   No	*	*
	Yes   No
	Yes   No

Give your full employment record, starting with your current or most recent employment

Dates Employed	Employer Name & Address	Employer Phone
From: * To: *	*
Job Title	Supervisor Name & Title	May we Contact?
		Yes No
Responsibilities	Reason for Leaving
*	*

Dates Employed	Employer Name & Address	Employer Phone
From: To:
Job Title	Supervisor Name & Title	May we Contact?
		Yes No
Responsibilities	Reason for Leaving

Dates Employed	Employer Name & Address	Employer Phone
From: To:
Job Title	Supervisor Name & Title	May we Contact?
		Yes No
Responsibilities	Reason for Leaving

Name	Relationship	Phone Number	Email
*	*

I understand and agree that:

1. All facts I have provided on this application, in any resume or other materials I have submitted, and during any job interview are true and complete. Any false or misleading statement, or misrepresentation or omission of any fact, on this application, resume or other material I have submitted, or during any job interview, will be grounds for not receiving an offer of employment, or a offer was accepted, immediate termination.

2. Any offer of employment I may receive from the company is contingent upon my successful completion of the total pre-employment screening process and new hire in-processing, including the Company receiving references that it considers satisfactory, and my satisfactory completion of any post-job offer pre-employment physical examination that the company may require. I understand that my refusal to undergo such examination will preclude me form obtaining and continuing employment. Further, I hereby authorize and agree that all medical information obtained in association with the post-offer examination shall be released from the appropriate medial information obtained in association with the post-offer examination shall be released from the appropriate medical personnel to the Company and release and hold harmless all persons, companies and other entries conducting such examination for all liability (ies) and damages whatsoever in association with such examination.

3. In understand that as a condition of employment, I may be required to undergo and successfully pass a test for alcohol and/or drugs. I understand that my refusal to be tested as a condition of employment or the failure to test negative will preclude me from obtaining employment. I also understand and agree that, if employed, I may be required to submit to an alcohol or drug test at any time at the discretion of the Company.

4. In processing my application for employment, the Company may verify and all of the information provided by me, or may procure or have prepared an investigative consumer report for this purpose concerning, among other things, my prior employment or military record, education, character, general reputation, personal characteristics, criminal record, and mode of living. The report may involve personal interviews with sources such as neighbors, friends or associates. I understand that upon request to the Company, I will be informed of whether an investigative consumer report was required and given full information as to the nature and scope of the investigation.

5. I authorize and request that all of my present and former employers, schools and those individuals I have listed as references furnish information about my employment/scholastic record. This may include the reason for the termination of my employment, work performance, abilities, school major, GPA, degree obtained etc. and other qualities pertinent to my qualifications for employment. I hereby release and hold harmless all parties from any and all liability for damages arising from furnishing the requested information.

6. I agree that, if hired, I will comply with the policies, rules and regulations and procedures of the Company and understand that I may resign at any time and the Company can terminate my employment at any time for any reason not prohibited by law. I understand and agree to the terms and conditions of my employment, if hired, can only be varied from this “at-will” arrangement through written documentation. I further understand that no employee of the Company, other than the President, has authority to enter into any agreement with me for employment for any specified period of time or to make any agreement different from or contrary to any Company policy. I further understand that any such agreement, if made, must be in writing and signed by me and by the Company President.

7. In consideration of the Company’s review of my application, I agree that any claim or lawsuit arising out of my employment with, or my application for employment with the Company or any of its affiliated companies, must be filed no more than six months after the date of the employment action that is to the subject of the claim or lawsuit. While I understand that the statute of limitations for claims arising out of an employment action may be longer than six months, I agree to be bound by the six-month period of limitation set forth herein, and I WAIVE ANY STATUTE OF LIMITATIONS TO THE CONTRARY.

* Signature (type name):

* Date: