Employment Application

START WITH YOUR PRESENT OR LAST JOB. INCLUDE ANY JOB-RELATED MILITARY SERVICE ASSIGNEMENT AND VOLUNTEER ACTIVITIES. You may exclude organizations, which indicate ethnic, color, religion, gender, national origin, or other protected status. For each job please list: - Employer Name, Address, Phone - Supervisor's Name - Dates Employed (From and To) - Job Title - Work Performed - Hourly Rate (Starting and Final) - Reason For Leaving

Government agencies at this time require periodic reports on the gender, ethnicity, handicap, veteran, and other protected status of employees. This data is for statistical analysis with respect to the success of the Affirmative Action program. Submission of this information is voluntary.

I certify that answers given herein are true and complete to the best of my knowledge. I authorize investigation of all statements contained in the application for employment as may be necessary in arriving at an employment decision. This application for employment shall be considered active for a period of time not to exceed three weeks. Any applicant wishing to be considered for employment beyond this time period should inquire as to whether or not application is being accepted at that time. I hereby understand and acknowledge that, unless otherwise defined by applicable law, any employment relationship with this organization is of an “at will” nature, which means that the employee may resign at any time and employer may discharge the employee at any time with or without cause. It is further understood that this “at will” employment relationship may not be changed by any written document or by conduct unless an authorized executive of this organization specifically acknowledges such change in writing. In the event of employment, I understand that false or misleading information given in my application or interview(s) may result in discharge. I understand, also that I am required to abide by all rules and regulations of the employer.