Employment Application

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Instructions

Please be as thorough as possible in each of your answers. We strongly encourage you to complete each field as we will be better able to determine your fit with our organization. If a question does not apply to you, please use N/A (Not Applicable).

What position would you like to apply for?

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State

When are you available to start?

What are your wage expectations?

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I certify that the answers given to the questions and the statements made (including statements on the attached resume, and inserted forms, if any) on this application and in the hiring process are true and correct to the best of my knowledge. I understand that a false statement, a false answer, an omission or a misleading statement may result in a decision not to hire me, the withdrawal of any offer of employment or the termination of my employment with the Company regardless of when such false, misleading or erroneous information is discovered.

Your application will be considered active for ninety (90) days only.

I understand that if hired, unless I am employed under a specific written contract or collective bargaining agreement, my employment with the company will be “at-will” and that my employment may be terminated at any time with or without cause and with or without notice at the option of the Company. I understand that no representative of the Company has any authority to make any assurances, representations or promises contrary to the “at-will” nature of my employment unless it is in writing by an authorized officer of the company. I understand that I may terminate my employment with or without cause and with or without notice at any time. I further agree that the Company reserves the right to make unilateral changes to the terms and conditions of my employment. I agree that this application represents the entire agreement between the Company and me and it supersedes any prior agreement or understanding I may have had, whether oral or written.

I understand that I may be required, after a conditional offer of employment, to submit to a background check, drug screening or test, and driving record check, as required for the position applied for, and as applicable under federal, state or local law.

I agree to waive my right to a trial by jury in any action or proceeding involving any claim, whether statutory or at common law, related to or arising out of my application; consideration for hire; failure to be hired; employment, should I become employed; or the termination of employment, including claims of discrimination, unless prohibited by applicable law. I understand that I am waiving my right to a jury trial voluntarily and knowingly and free from duress or coercion. I understand that this does not prevent me from filing a claim or a charge with the Equal Employment Opportunity Commission, U.S. Department of Labor, National Labor Relations Board, or any other government or administrative agency, nor does this prevent me from making a claim for workers' compensation, state disability or unemployment insurance benefits.

I understand that I have the right to consult with a person of my choosing, including an attorney, before signing this document.

This application does not constitute a promise or guarantee of employment.

I have carefully read this declaration and by my signature below I acknowledge my understanding of its contents. Type your name below as your electronic signature.
Equal Employment Opportunity
We are an Equal Opportunity employer and do not discriminate on the basis of race, ancestry, color, religion, sex, age, marital status, sexual orientation, national origin, medical condition, disability, veteran status, or any other basis protected by law.

The Information provided will be used for research, reporting, statistical purposes and to monitor legal compliance. To help us comply with these government requirements, please complete the following information.

Completion of this form is voluntary and will not affect your opportunity for employment or terms or conditions of employment if hired. We appreciate your cooperation.

Gender




Ethnicity

Race (do not respond if you selected "Hispanic or Latino" above)
A person having origins in any of the original peoples of Europe, the Middle East, or North Africa
A person having origins in any of the original peoples of the Far East, Southeast Asia, or the Indian Subcontinent, including, for example, Cambodia, China, India, Japan, Korea, Malaysia, Pakistan, the Philippine Islands, Thailand, and Vietnam
A person having origins in any of the original peoples of North and South America (including Central America), and who maintain tribal affiliation or community attachment
A person having origins in any of the black racial groups of Africa
A person having origins in any of the peoples of Hawaii, Guam, Samoa, or other Pacific Islands
A all persons who identify with more than one of the above five races

Protected Veterans
The definitions of protected veterans are listed below. Use the boxes following the definitions to indicate whether you are a protected veteran
Disabled Veteran
A "disabled veteran" is one of the following:

A veteran of the U.S. military, ground, naval or air service who is entitled to compensation (or who but for the receipt of military retired pay would be entitled to compensation) under laws administered by the Secretary of Veterans Affairs; or

A person who was discharged or released from active duty because of a service-connected disability.
Recently Separated Veteran
A "recently separated veteran" means any veteran during the three-year period beginning on the date of such veteran's discharge or release from active duty in the U.S. military, ground, naval, or air service.
Active Duty Wartime or Campaign Badge Veteran
An "active duty wartime or campaign badge veteran" means a veteran who served on active duty in the U.S. military, ground, naval or air service during a war, or in a campaign or expedition for which a campaign badge has been authorized under the laws administered by the Department of Defense.
Armed Forces Service Medal Veteran
An "armed forces service medal veteran" means a veteran who, while serving on active duty in the U.S. military, ground, naval or air service, participated in a United States military operation for which an Armed Forces service medal was awarded pursuant to Executive Order 12985.

Disability Status
You are considered to have a disability if you have a physical or mental impairment or medical condition that substantially limits a major life activity, or if you have a history or record of such an impairment or medical condition.


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