Employment Form


  • Position Information

  • MM slash DD slash YYYY
  • Employment History

  • Please provide all employment information beginning with THE MOST RECENT of your past 3 employers.

  • EmployerPosition HeldAddressSupervisorSupervisor Phone 
  • Dates Employed:Salary:Job Summary:Reason for Leaving: 
  • Educational History

    List school name and location, years completed
  • Completeness and Accuracy of Information

    I represent that all of the information given to me in support of my application for employment is true and complete. I understand that any false, omitted or misleading information submitted during the application process will disqualify me from consideration for hire. If I have already been hired before the falsification or omission is discovered, my employment will be terminated. Information not specifically requested on the application will render the employment application unacceptable.
  • Authorization for Release of Information and Release from Liability

    I acknowledge that a routine inquiry may be made which will provide applicable information concerning my character, general reputation, personal characteristics, and mode of living. I authorize you to verify any of the information given during the application process with appropriate individuals, companies, institutions, or agencies and I authorize them to release such information as you require, including my prior disciplinary employment records, criminal background, past employment, and education. In accordance with the Fair Credit Reporting Act (FCRA) and other applicable regulations, I have a right to the nature and scope of any investigation report that is made. I release you and them from liability as a result of those inquiries and disclosures. A photocopy or other electronic reproduction of this authorization/release is binding and may be relied upon.
  • No Written, Oral or Implied Contracts

    I understand that all employment with the Company is “at will”. This means that just as an employee has the right to terminate the employment relationship at any time, with or without reason, the Company retains a similar right. I understand that any written company documents, or any oral statements made either during the application process, or, if I am employed, after I am employed should not be relied upon by me as altering the general policy. I acknowledge that only the President of the Company has the authority to alter the at-will nature of employment, and then only by written contract specifically signed by the President of the Company.
  • This field is for validation purposes and should be left unchanged.