Employment Application

Answering “Yes,” to these questions does not constitute an automatic rejection for employment. Date of
the offense, seriousness and nature of the violation, rehabilitation, and position applied for
will be considered.

Education

Summarize Your Special Skills or Qualifications

Previous Employment (begin with most recent position)

I certify that the facts contained in this application are true and complete to the best of my knowledge and understand that, if employed, falsified statements on this application shall be grounds for dismissal. I authorize investigation of all statements contained herein and the references and employers listed above to give you any and all information concerning my previous employment and any pertinent information that they may have, personal or otherwise, and release the company from all liability for any damage that may result from utilization of such information. I also understand and agree that no representative of the company has any authority to enter into any agreement for employment for any special period of time, or to make any agreement contrary to the foregoing, unless it is in writing and signed by an authorized company representative. This waiver does not permit the release or use of disability-related or medical information in a manner prohibited by the Americans with Disabilities Act (ADA) or other relevant federal and state laws.

By submitting this application, you are agreeing that the information is accurate.