Application for Employment

Name *

First Name

Last Name

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone *

(###)

###

####

Do you have reliable transportation to work? *

Yes

No

Are you at least 18 years old? *

Yes

No

Are you legally eligible for employment in the U.S.? *

Proof of U.S. citizenship or immigration status is required if hired.

Yes

No

Have you been convicted of a crime?

Massachusetts applicants should not include misdemeanor convictions; California applicants should not include marijuana-related convictions that occurred more than 2 years prior to the application date.

Yes

No

Are you a veteran?

Yes

No

Start date of service

If you are a vetern, give dates of service.

MM

DD

YYYY

End date of service

If you are a vetern, give dates of service.

MM

DD

YYYY

Type of employment preferred *

Are you seeking full time, part time, or temporary employment?

Full Time

Part Time

Temporary

Are you willing to work overtime?

Yes

No

Are you willing to work holidays?

Yes

No

Are you willing to work weekends?

Yes

No

Are you currently employed?

Yes

No

When would you be able to start?

If hired

MM

DD

YYYY

Enrolled in a recognized co-op program?

If you are in High School

Yes

No

Authorizations & At-Will Employment Agreement

(Please read carefully, then check the I agree box and date below) I certify that I have personally completed this application. I declare that the information provided in this employment application is true and complete and I understand that any false information or significant omissions may disqualify me from further consideration for employment and may be justification form my dismissal from employment if discovered at a later date. I agree to immediately notify this company if I should be convicted of a crime while my job application is pending or during my employment, if hired. I authorize this company to make an investigation of all information contained in this employment application and I release from liability all companies and corporations supplying such information. I understand any false answers, statements, or implications made by me on this application or other required documents shall be considered sufficient cause for denial of employment or discharge. I specifically authorize and direct my current and former employers to supply employment-related information to this company and do hereby release my current and former employers from liability for providing information to this company. Upon termination of my employment for whatever reason, I release this company from all liability for supplying any information concerning my employment to any potential employer. I authorize this company, if applicable, to request a copy of my credit report, motor vehicle driving record, and any other investigative report deemed necessary through various third party sources. As required by law, upon request within a reasonable period of time, I will be notified as to the nature and scope of such investigations. I hereby agree to submit to any drug test required of me, whether prior to my employment or if employed by this company at any time thereafter. If requested, I will take a post-job offer physical examination and my employment, in the event I receive medical treatment for any condition, including a physical, psychological, emotional, or psychiatric condition that is job-related, I hereby authorize the limited release and exchange of such medical information relating to my condition between the treatment provider and a company-designated physician. AT-WILL EMPLOYMENT AGREEMENT I understand and agree that nothing contained in this application, or conveyed during any interview is intended to create an employment contract between the company and me. In addition, I understand and agree that if you employ me, in consideration of my employment, my employment and compensation will be at-will, for no definite period of time, and may be terminated at any time, for any reason, or for no reason at all. I understand that only the company’s President is authorized to change the employment-at-will status and such a change can only be done in writing. I have read, understand, and agree to the above.

I agree

I don't agree

Please enter today's date

MM

DD

YYYY