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employment application

Contact Information

Are you 18 years or older?

Have you ever worked or attended school under another name? If so, under what name?:

Are you either a citizen or authorized to
work in the U.S.?

Have you ever been convicted of a crime?**

** A “yes” answer will not automatically disqualify you from employment. We will consider the nature and date of the offense and the job for which you are applying for job-related purposes only, and only to the extent permitted by applicable law.

Position Desired

Do you prefer:

Have you previously worked for this company? If so:

Are you able to work:


* if required for the position for which you’re applying


Are you familiar with personal computers?

Can you type?

Military Experience

Work Experience

Work Experience 1

May we contact?

Work Experience 2

May we contact?

Work Experience 3

May we contact?


Please list three references other than relatives or previous employers.

Reference 1

Reference 2

Reference 3

Authorization and Acknowledgements

I certify that the facts contained in this application are true and complete to the best of my knowledge. I understand that if I am employed, any false statements on this application may be grounds for dismissal.

I authorize investigation of all statements contained in this application. I also grant permission to contact all references listed above, and authorize them to release all information concerning my previous employment and any other pertinent information these references might have, personal or otherwise. I release all parties from all liability for any damage that may result from furnishing this information to you.

I understand and agree that, if hired, my employment is for no definite period and may be terminated at any time and without prior notice.