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**Conviction does not automatically bar you from employment. All circumstances will be considered.
Share the name of the educational institution, its address, the dates you attended, your graduation date, your field of study, and your degree obtained.
Give the names of three (3) individuals not related to you who have known you for at least one (1) year.
PLEASE READ THE FOLLOWING STATEMENT CAREFULLY
You will be asked to agree to and date this statement at the bottom. Applications submitted without these fields completed will not be considered.
- I certify that I am genuinely interested in the position for which I have applied and this application has not been made for any other purpose or under false pretenses.
I certify that the answers given by me to the foregoing questions and statements are true, correct and complete to the best of my knowledge and that I have withheld nothing that would, if disclosed, affect this application unfavorably. I understand that any falsification, misrepresentation, omission, misleading, or incorrect statements may render this application void, and
if I were to be employed, would be cause for my termination without liability, whenever discovered. I understand and agree that any dishonesty or falsification by me during my employment may result in immediate termination.
I authorize my employer to conduct any investigation it deems appropriate concerning my application. I hereby authorize
and request former employers, personal references, schools, and all other persons and organizations to disclose any information that may be sought in connection with this application. In return for their providing such information to my employer or its agents, I hereby release all former employers, personal references, schools, and other persons and
organizations from all liability in connection with those disclosures.
I further authorize my employer to disclose to others any information it may have concerning my employment, character, and qualifications, including information gained from this application and the investigation of this application. In return for its accepting and considering my application and for any employment that it may offer to me, I hereby release my employer from all liability in connection with those disclosures.
I authorize the company to release to other prospective employers and governmental authorities any information
regarding my employment with the company or the information set forth in this application or gained by the company from other companies, schools, or persons named in the application, and to give out any information regarding my employment, character, qualifications, and information they may have regarding me, whether or not it is in their records. I hereby release the company from any and all liability for any damage flowing from issuing this information.
As a condition of hire and of continued employment, I agree to submit to physical examinations permitted by applicable law (including, but not limited to, blood, urine, and other tests for drugs, alcohol, HIV, HBV), at the company's expense, by persons designated by the company, whenever the company requests, and to submit to any other tests or examinations (including polygraph), permitted by applicable law, that the company requests now or at any time during my employment.
I acknowledge that the company reserves the right to inspect all property (including cars, purses, lockers, desks, lunch boxes, packages, and other containers) on the company's premises and, if employed, I agree to cooperate with such inspections as a condition of continued employment. I also agree that the company has permission to photograph me while on company property and to utilize these photographs in furtherance of the company's business.
I further acknowledge that I understand the company, and its employees, will from time to time monitor my performance and activities during working time or while I am on company property by electronic, video, and/or voice transmittal and receiving equipment, e.g., taping of telephone conversations. I also acknowledge that the company has my permission to engage in such monitoring and fully release, forgive, and acquit the company, its officers, employees, and agents of any
claim or complaint whatsoever that I may have against them relating directly or indirectly to this monitoring activity.
In consideration of the compensation to be paid to me as an employee, and the facilities and data to be made available to me by the company, I hereby recognize as the exclusive property of the company, any confidential information regarding various phases of company business and I hereby agree to keep such information confidential.
I acknowledge that if employed by the company, my employment and compensation is for an indefinite period of time and can be terminated, with or without cause, and with or without notice, at any time, at the option of either the company or myself. I understand that no representative of the company, other than the President or his designee, has the authority to enter into any agreement contrary to the foregoing, and then only if such commitment is in a written document signed by the
President or his designee. If employed, I further agree that the company may, at any time, without notice to or agreement by me, make unilateral changes in any of its policies, practices, rules, procedures, and compensation and benefits provided employees.
This application for employment will become void and no longer be considered upon the occurrence of any one of the following: (1) the position for which I have applied has been filled; (2) I have accepted other employment; or (3) 90 calendar days have passed since I completed this application. I understand I must submit a new application if I want to be considered for employment after that time.
This application is the property of my employer and is not intended for reproduction.
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