Application For Employment

We are an equal opportunity employer. Applicants are considered for positions without regard to veteran status, uniformed servicemember status, race, religion, sex, national origin, age, physical or mental disability, genetic information or any other category protected by applicable federal, state, or local laws.

THIS COMPANY IS AN AT-WILL EMPLOYER AS ALLOWED BY APPLICABLE STATE LAW. THIS MEANS THAT REGARDLESS OF ANY PROVISION IN THIS APPLICATION, IF HIRED, THE COMPANY OR I MAY TERMINATE THE EMPLOYMENT RELATIONSHIP AT ANY TIME, FOR ANY REASON, WITH OUR WITHOUT CAUSE OR NOTICE.

Please Answer All Questions. Resumes are not a substitute for a completed application. Following the Application For Employment, please complete the Pre-Employment Questionnaire.

ALL FIELDS ARE REQUIRED

Position Applying For: Select from the list of positions below:

First and Last Name:

Telephone Number (please include area code):

Alternate or Cellular Telephone Number (Please include Area Code):

Email Address:

Present Address: Street, Apartment, or Unit Number:

City, State and Zip Code:

How long have you lived there? Please answer in Years and Months:

Previous Address: Street, Apartment, or Unit Number:

City, State and Zip Code:

How long did you live there? Please answer in Years and Months:

Desired Salary/Hourly Rate:

If under the age of 18, can you produce the necessary work certificate at the time of employment?
YesNo

Type of employment desired?
Part-timeFull-time

Specify Part-time Hours:

Are you willing to work overtime?
YesNo

Date on which you can start work if hired:

Have you previously applied for employment with this Company?
YesNo

If Yes, when and where did you apply?

Have you ever been employed by this Company?
YesNo

If Yes, provide dates of employment, location, and reason for separation from employment:

INSTRUCTIONS FOR ANSWERING THE NEXT TWO QUESTIONS

1. All applicants: Do not include convictions that were sealed, eradicated, erased, annulled by a court, or expunged, or convictions that resulted in referral to a diversion program.

2. California applicants: Do not include misdemeanor marijuana-related convictions that are more than two (2) years old or misdemeanor convictions for which probation was successfully completed or otherwise discharged and the case was judicially dismissed.

3. Washington applicants: Limit any response to the past ten (10) years.

4. Oregon applicants: Regarding arrests, limit your response to pending charges that are less than one (1) year old.

Have you ever plead guilty or no contest to, or been convicted of any criminal offense other than the applicable exceptions listed above?
YesNo

Have you ever been arrested for any matters for which you currently are out on bail or on your own recognizance pending trial?
YesNo

CRIMINAL OFFENSES ONLY: If you answered Yes, to either of the above two questions, please provide the date(s) and explain in accordance with the above instructions so that individual circumstances can be considered.

Have you ever initiated an act of violence in the workplace?:
YesNo

If Yes, please provide the date(s) and explain so that individual circumstances can be considered. (A "Yes" answer will not disqualify you from employment.)

List all special technical skills that you feel qualify you for the job for which you are applying (For example., computer programming/language, software, equipment operation, special tools for machines, etc.)

Education- Please list the School Name and Location (Address, City, State), Course of Study, Number of Years Completed, Degree/Major and whether or not you Graduated:

Choose from one or more of the following categories: High School, College, Bus./Tech./Trade or Post College:

Honors Received:

If applicable, list below any other names by which you have been known which may be necessary to allow us to confirm your work and educational record. For example, change of name, use of an assumed name, nickname, etc.

WORK EXPERIENCE

Please list the names of your present and/or previous employers in chronological order with present or last employer listed first. Account for ALL periods of time including any period of unemployment. If self-employed, supply firm name and business references. You may include any verifiable work performed on a volunteer basis, internships, or military service. Your failure to completely respond to each inquiry may disqualify you for consideration from employment.

Name, Address and Type of Business of Employer:

Telephone with Area Code:

Dates Employed, from start to finish:

Job Title and Duties:

Supervisor's Name:

May we contact them?
YesNo

If not, why not?

Start and Final Wages:

Reason for Leaving:

What will this employer say was the reason your employment terminated?

How much notice did you give when resigning? If none, explain:

Name, Address and Type of Business of Employer:

Telephone with Area Code:

Dates Employed, from start to finish:

Job Title and Duties:

Supervisor's Name:

May we contact them?
YesNo

If not, why not?

Start and Final Wages:

Reason for Leaving:

What will this employer say was the reason your employment terminated?

How much notice did you give when resigning? If none, explain:

Name, Address and Type of Business of Employer:

Telephone with Area Code:

Dates Employed, from start to finish:

Job Title and Duties:

Supervisor's Name:

May we contact them?
YesNo

If not, why?

Start and Final Wages:

Reason for Leaving:

What will this employer say was the reason your employment terminated?

How much notice did you give when resigning? If none, explain:

Please explain fully all gaps in your employment history in excess of one month:

Have you ever been terminated or asked to resign from any job?
YesNo

If Yes, how many times?

Has your employment ever been terminated by mutual agreement?
YesNo

If Yes, how many times?

Have you ever been given the choice to resign rather than be terminated?
YesNo

If Yes, how many times?

If you answered Yes to any of the above three questions, please explain the circumstances of EACH occasion.

REFERENCES

Please list the names of additional work-related references we may contact. Individuals with no prior work experience may list school or volunteer-related references.

Name, Position, Company, Work Relationship and Telephone Number:

Name, Position, Company, Work Relationship and Telephone Number:

Please list the names of personal references (not previous employers or relatives) who know you well that we may contact.

Name, Occupation, Address, Telephone and Number of Years Known:

APPLICATION CERTIFICATION

I understand and agree that if driving is a requirement of the job for which I am applying, my employment and/or continued employment is contingent on possessing a valid driver's license for the state in which I reside and automobile liability insurance in an amount equal to the minimum required by the state where I reside.

I understand that the Company may now have, or may establish, a drug-free workplace or drug and/or alchohol testing program consistent with applicable federal, state, and local law. If the Company has such a program and I am offered a conditional offer of employment, I understand that if a pre-employment (post-offer) drug and/or alcohol test is positive, the employment offer may be withdrawn. I agree to work under the conditions requiring a drug-free workplace, consistent with applicable federal, state, and local law. I also understand that all employees of the location, pursuant to the Company's policy and federal, state, and local law, may be subject to urinalysis and/or blood screening or other medically recognized tests designed to detect the presence of alcohol or illegal or controlled drugs. If employed, I understand that the taking to alcohol and/or drug tests is a condition of continual employment and I agree to undergo alcohol and drug testing consistent with the Company's policies and applicable federal, state, and local law.

If employed by the Company, I understand and agree that the Company, to the extend permitted by federal, state, and local law, may exercise its right, without prior warning or notice, to conduct investigations of property (including, but not limited to, files, lockers, desks, vehicles, and computers) and, in certain circumstances, my personal property.

I understand and agree that as a condition of employment and to the extent permitted by federal, state, and local law, I may be required to sign a confidentiality, restrictive covenant, and/or conflict of interest statement, as well as an agreement to arbitrate.

I certify that all the information on this application, my resume, or any supporting documents I may present during any interview is and will be complete and accurate to the best of my knowledge. I understand that any falsification, misrepresentation, or omission of any information may result in disqualification from consideration for employment or, if employed, disciplinary action, up to and including immediate dismissal.

THIS COMPANY IS AN AT-WILL EMPLOYER AS ALLOWED BY APPLICABLE STATE LAW. THIS MEANS THAT REGARDLESS OF ANY PROVISION IN THIS APPLICATION, IF HIRED, THE COMPANY OR I MAY TERMINATE THE EMPLOYMENT RELATIONSHIP AT ANY TIME, FOR ANY REASON, WITH OR WITHOUT CAUSE OR NOTICE. NOTHING IN THIS APPLICATION OR IN ANY DOCUMENT OR STATEMENT, WRITTEN OR ORAL, SHALL LIMIT THE RIGHT TO TERMINATE EMPLOYMENT AT-WILL. NO OFFICER, EMPLOYEE OR REPRESENTATIVE OF THE COMPANY IS AUTHORIZED TO ENTER INTO AN AGREEMENT--EXPRESS OR IMPLIED--WITH ME OR ANY APPLICANT FOR EMPLOYMENT FOR A SPECIFIED PERIOD OF TIME UNLESS SUCH AN AGREEMENT IS IN A WRITTEN CONTRACT SIGNED BY THE PRESIDENT OF THE COMPANY.

If hired, I agree to conform to the rules and regulations of the company, and I understand that the company has complete discretion to modify such rules and regulations at any time, except that it will not modify its policy of employment at-will.

I authorize the Company or its agents to confirm all statements contained in this application and/or resume as it relates to the position I am seeking and to the extent permitted by federal, state, or local law. I agree to complete any requisite authorization forms for the background investigation.

I authorize and consent to, without reservation, any party or agency contacted by this employer to furnish the above-mentioned information. I hereby release, discharge, and hold harmless, to the extent permitted by federal, state, and local law, any party delivering information to the Company or its duly authorized representative pursuant to this authorization from any liability, claims, charges, or causes of action which I may have as a result of the delivery or disclosure of the above requested information. I hereby release from liability the Company and its representative for seeking such information and all other persons, corporations, or organizations furnishing such information.

If hired by this Company, I understand that I will be required to provide genuine documentation establishing my identity and eligibility to be legally employed in the United States by this Company. I also understand this Company employs only individuals who are legally eligible to work in the United States.

THIS APPLICATION WILL BE CONSIDERED ACTIVE FOR A MAXIMUM OF SIXTY (60) DAYS. IF YOU WISH TO BE CONSIDERED FOR EMPLOYMENT AFTER THAT TIME, YOU MUST REAPPLY.

I certify that all of the information that I have provided on this application is true, accurate, and complete.
YesNo

Please submit your electronic signature in the space provided below.

Applicant Signature - First and Last Name:

Please enter the Day/Month/Year below:

If the applicant is a minor, the foregoing release and consent must be signed by the applicant's parent or legal guardian. Signature by the applicant's parent or legal guardian constitutes acknowledgement by the applicant and the parent or legal guardian that the Company, to the extent permitted by federal, state, and local law, can test the applicant for illegal or controlled substances, conduct inspections of property without notice, and communicate test results to Company personnel who need to know, the applicant, and the applicant's legal guardian.

Parent/Legal Guardian:First and Last Name
Please submit your electronic signature in the space provided below.

Witness Signature: First and Last Name
Please submit your electronic signature in the space provided below.

Please enter the Day/Month/Year below:

I have read and understand the above statement.
Please submit your electronic signature in the space provided below.

Applicant Signature: First and Last Name

Please enter the Day/Month/Year below:

Please upload your Cover Letter below:

Please upload your Resume below: