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Employment Application

PLEASE READ CAREFULLY
Note: Fields marked with a * require an answer. Please use "N/A" for "not applicable" if necessary. Applicants may be required to complete and sign a paper application for employment upon interview.
Attach Resume:
*Email:
Applying for:

Applicant Information

*First Name: *Last Name:
MI: *Social Security:
*Address: Apartment/Unit #
*City *State
*Zip
*Phone: Referred By:
Date Available:

Salary Expected:
I can work:  Weekends    Evening    Night
U.S. Citizen:    Yes    No If not, are you authorized to work in the U.S.?:  Yes     No
Languages Spoken:
*Have you ever worked for this company?:  Yes     No
If yes, when?: ------ To ------
*Do you have any relatives or friends currently working for this Company or related Company?:  Yes     No
If so, please give your relationship
*Have you ever been convicted of a felony?
(By company policy some misdemeanors may bar employment):
 Yes     No
If yes, explain briefly:
Do you have any special training or skills that would be of use in the job you are applying for?

Education

High School:   Address:
Graduate:    Yes     No   Degree:
College:   Address:
Graduate:    Yes     No   Degree:
Graduate School:   Address:
Graduate:    Yes     No   Degree:
Other:   Address:
Graduate:    Yes     No   Degree:

References

Please list three references not related to you, whom you have known at least one year.
Name: Occupation:
Company: Day Phone Numbers:
Address:
Name: Occupation:
Company: Day Phone Numbers:
Address:
Name: Occupation:
Company: Day Phone Numbers:
Address:

Employment History

Company Name: Complete Address
(w/ City, State, Zip):
Phone: Supervisor:
Job Title: Responsibilities:
Starting Salary: Ending Salary:
Start Date:
(mm/dd/yyyy)
  End Date:
(mm/dd/yyyy)
 
Reason for Leaving: May we contact your previous employer for a reference?  Yes    No

Military Service

Start Date:
(mm/dd/yyyy)
End Date:
(mm/dd/yyyy)
Branch: Rank at Discharge:
Type of Discharge: If other than honorable, explain:

Applicant's Statement

Notification and Agreement

I understand that nothing in the Application is to be considered as an em- ployment contract. Texas, Oklahoma and New Mexico are at will employ- ment states, therefore I may terminate my employment at any time, and the Company has similar rights.

By signing below I am stating that all the information I have given on this Em-ployment Application (the "Application '') is correct. I understand that if I knowingly lie on the Application that I will be subject to immediate termination by the Company. I further understand that the Immigration Reform and Control Act of November 6, 1986 requires that I prove that I am eligible to work in the United States of America and that failure to provide such proof as may be required may prevent my employment with the Company or be cause for the termination of employment with the Company.

THIS COMPANY USES AN EMPLOYEE DISPUTE RESOLUTION PLAN WHICH RE-QUIRES ARBITRATION TO RESOLVE LEGAL EMPLOYMENT DIS-PUTES. THE EMPLOYEE DISPUTE RESOLUTION PLAN IS THE EXCLUSIVE MEANS OF RESOLVING EMPLOYMENT-RELATED LEGAL CLAIMS. ALL PERSONS WHO APPLY FOR EMPLOYMENT, ACCEPT EMPLOYMENT, OR CONTINUE WORKING FOR THE COMPANY AGREE TO RESOLVE ALL SUCH CLAIMS THROUGH THE BINDING ARBITRATION PROCESS DESCRIBED IN THE EMPLOYEE DISPUTE RESOLUTION AGREEMENT. IF YOU WOULD LIKE TO SEE THE AGREEMENT, PLEASE ASK FOR A COPY.


FAIR CREDIT REPORTING ACT
NOTICE OF INTENT TO OBTAIN A CONSUMER REPORT

This is to inform you that as a part of the Company’s procedure for processing your employment application, or for otherwise determining your eligibility for a position with our Company as a current or prospective employee, we may obtain a consumer report or an investigative consumer report from a consumer reporting agency.

The report we obtain may contain information regarding your credit worthiness, credit standing, credit capacity, character, general reputation, personal characteristics, criminal history, or mode of living from public record or other sources or through personal interviews with your neighbors, friends, or associates. Prior to procuring such a report, you will receive an authorization form from the Company requiring your signature.


Signature below verifies you have read the above notice and understand what it means.

Please note, an application for employment with the Company is active for 30 days ONLY. After 30 days the application is void and will no longer be considered for any employment position with the Company.



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