If yes, when?
 

If yes, when?
 

(Include any plea of "guilty" or "no contest." Exclude minor traffic violations.) If yes, give details.
 
(A conviction will not necessarily disqualify an applicant for employment.)

If yes, please explain.
 

Driver's License Number
 
Class of License
 
State Licensed in
Alabama Alaska Arizona Arkansas California Colorado Connecticut District of Columbia Delaware Flordia Georgia Hawaii Iowa Idaho Illinois Indiana Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming  

If yes, give details
 

Name of Employer

Address

City, State, Zip Code

Telephone (###-###-####)


Title

Duties

Supervisor

Employed
From (MM/YYYY)
To (MM/YYYY)
Pay
Start $
Final $

Reason For Leaving


Add an additional Employer...

Name of Employer

Address

City, State, Zip Code

Telephone (###-###-####)


Title

Duties

Supervisor

Employed
From (MM/YYYY)
To (MM/YYYY)
Payb>
Start $
Final $

Reason For Leaving


Add an additional Employer...

Name of Employer

Address

City, State, Zip Code

Telephone (###-###-####)


Title

Duties

Supervisor

Employed
From (MM/YYYY)
To (MM/YYYY)
Pay
Start $
Final $

Reason For Leaving

If yes, give names
 

If yes, whom do you suggest we contact?
 

If yes, please explain
 

Affidavit
Please Read Each Statement Carefully Before Signing

I certify that all information provided in this employment application is true and complete. I understand that any false information or omission may disqualify me from further consideration for employment and may result in my dismissal if discovered at a later date.

I authorize the investigation of any or all statements contained in this application. I also authorize, whether listed or not, any person, school, current employer, past employers and organizations to provide relevant information and opinions that may be useful in making a hiring decision.  I release such persons and organizations from any legal liability in making such statements.

I understand I may be required to successfully pass a drug screening examination. I hereby consent to a pre and/or post employment drug screen as a condition of employment, if required.

I understand that if I am extended an offer of employment it may be conditioned upon my successfully passing a complete pre-employment physical examination.  I consent to the release of any or all medical information as may be deemed necessary to judge my capability to do the work for which I am applying.

I UNDERSTAND THAT THIS APPLICATION, VERBAL STATEMENTS BY MANAGEMENT, OR SUBSEQUENT EMPLOYMENT DOES NOT CREATE AN EXPRESS OR IMPLIED CONtrACT OF EMPLOYMENT NOR GUARANTEE AUTHORITY TO ENTER INTO AN AGREEMENT OF EMPLOYMENT FOR ANY SPECIFIED PERIOD AND SUCH AGREEMENT MUST BE IN WRITING, SIGNED BY THE PRESIDENT AND THE EMPLOYEE.  IF EMPLOYED, I UNDERSTAND THAT I HAVE BEEN HIRED AT THE WILL OF THE EMPLOYER AND MY EMPLOYMENT MAY BE TERMINATED AT ANY TIME, WITH OR WITHOUT REASON AND WITH OR WITHOUT NOTICE.

I have read, understand, and by my signature consent to these statements.