Application for Employment ALL POTENTIAL EMPLOYEES ARE EVALUATED WITHOUT REGARD TO RACE, COLOR, RELIGION, GENDER, NATIONAL ORIGIN, AGE, MARITAL OR VETERAN STATUS, THE PRESENCE OF A NON-JOB RELATED HANDICAP OR ANY OTHER LEGALLY PROTECTED STATUS. Position Sought(Required) How did you learn about the position?(Required) Name(Required) Address(Required) Street Address City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Home PhoneOffice PhoneOther PhoneEmail Social Security Number On what date would you be available for work? MM slash DD slash YYYY Desired Wage/Salary $Are you a U.S. citizen, or are you otherwise authorized to work in the U.S. without any restriction? Yes No Have you ever been involuntarily terminated or asked to resign from any position of employment? Yes No If yes, please describe circumstances: If selected for employment, are you willing to submit to a pre-employment drug screening test? Yes No EDUCATION School Name Location Years Attended Degree Received Major Actions Edit Delete There are no Entries. Add Entry Maximum number of entries reached. Other training, certifications, or licenses held List other information pertinent to the employment you are seeking EMPLOYMENT Employer Job Title Phone Supervisor Ending Salary Actions Edit Delete There are no Entries. Add Entry Maximum number of entries reached. I certify that answers given herein are true and complete to the best of my knowledge. 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 45 days. Any applicant wishing to be considered for employment beyond this time period should inquire as to whether or not applications are 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 the Employer may discharge 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 such change is specifically acknowledged in writing by an authorized executive of this organization. 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. I Agree