CONTACT INFORMATION

EMPLOYMENT DESIRED

PERSONAL INFORMATION

EDUCATION, TRAINING AND EXPERIENCE

EMPLOYMENT HISTORY

MILITARY SERVICE

REFERENCES

List three persons not related to you who have knowledge of your performance over the last few years

Please Read Carefully, and Sign Below

I hereby certify that I have not knowingly withheld any information that might adversely affect my chances for employment and that the answers given by me are true and correct to the best of my knowledge. I further certify that I, the undersigned applicant, have personally completed this application. I understand that any omission or misstatement of material fact on this application or on any document used to secure employment shall be grounds for rejection of this application or for immediate discharge if I am employed, regardless of the time elapsed before discovery.

I hereby authorize this company and Employer’s Guardian to thoroughly investigate my references, work record, education and other matters related to my suitability for employment and, further, authorize the references I have listed to disclose to the Company any and all letters, reports and other information related to my work records, without giving me prior notice of such disclosure. In addition, I hereby release the Company, my former employers and all other persons, corporations, partnerships and associations from any and all claims, demands or liabilities arising out of or in any way related to such investigation or disclosure.

I hereby authorize this company and Employer’s Guardian to thoroughly investigate my references, work record, education and other matters related to my suitability for employment and, further, authorize the release of all information obtained by Employer’s Guardian, LLC. while performing Human Resources, Payroll, Workers’ Compensation Administration, OSHA and other employer related duties for other organizations where the applicant may have applied for employment, interviewed for a job opportunity or been employed over the past five years. In addition, I hereby release the Company, my former employers and all other persons, corporations, partnerships and associations from any and all claims, demands or liabilities arising out of or in any way related to such investigation or disclosure.

I understand that nothing contained in the application, or conveyed during any interview which may be granted or during my employment, if hired, is intended to create an employment contract between me and the Company. In addition, I understand and agree that if I am employed, my employment is for no definite or determinable period and may be terminated at any time, with or without prior notice, at the option of either myself or the Company, and that no promises or representations contrary to the foregoing are binding on the Company unless made in writing and signed by me and the Company's designated representative.

Should a search of public records (including records documenting an arrest, indictment, conviction, civil judicial action, tax lien or outstanding judgment) be conducted by internal personnel employed by the Company, I am entitled to copies of any such public records obtained by the Company unless I mark the check box below. If I am not hired as a result of such information, I am entitled to a copy of any such records even though I have checked the box below.

Maximum file size: 50MB

* Applications are considered active for employment consideration for sixty (60) days. If you wish to be considered for any openings after sixty (60) days, please submit an updated application.

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