Position Applied for
First Name
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Middle Name
Last Name
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Phone
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Email
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If yes, give date
If yes, give date
On what date would you be available for work?
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If yes, please explain
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Do you have any special skills?
U.S. Military or Naval Service?
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Discharge Date & Rank
Describe accommodation, if any required
Education
I certify that answers given herein are true and complete to the best of my knowledge and understand that if any false information, omissions, or misrepresentations are discovered, my application may be rejected and, if I am employed my employment may be terminated at any time.
I authorize investigation of all statements contained in this 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 60 days. Any applicant wishing to be considered for employment beyond this time period should inquire as whether or not applications are 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 the Employer may discharge an
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 a change in writing. I understand, also, that I am required to abide by all rules and regulations of the employer.
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.
After reading the job description for the position, you are able to perform the requirements of the Essential Functions of the position, with or without, a reasonable accommodation.
I also understand and agree that the terms and conditions of my employment may be changed, with or without cause, and with or without notice, at any time by the company. I understand that no company representative, other than its president, and then only
when in writing and signed by the president, has the authority to enter into any agreement for employment for any specific period of time, or to make any agreement contrary to the foregoing.
If you are human, leave this field blank.
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