Personal Information

Please specify the hours that you are able to work below:
(Note: weekends are required for most positions)

On what date are you available to start work?

If you answered "Yes" to either question, please explain:
Note: A conviction record will not necessarily be a bar to employment, and factors such as the applicant's age at the time of the offense, the age of the offense, and the nature and seriousness of the violation will be taken into account.

Education

High School

College

Specialized Training

Do you have any special skills or licenses you'd like to tell us about and/or a specific job you are applying for?

Driving Information

If applying for a driver's position, please complete the following:

All candidates for driving positions will have their driving record checked. Employment for these positions is based on qualifications and verifications of a satisfactory driving record. All drivers will be drug tested.

Personal References

Do not list family members.

Reference 1

Reference 2

Reference 3

Employment History

Most recent position first.

Employer #1

May we contact this employer?
—Please choose an option—YesNo
If no, why not?
Employer #2

May we contact this employer?
—Please choose an option—YesNo
If no, why not?

AUTHORIZATION FOR EMPLOYMENT CONSIDERATION

1. In consideration of any employment by your Company, I agree that my employment is at the will of the Company, which means that the Company has the right to discharge me or lay me off at any time, with or without cause and with or without notice.  It is expressly agreed and understood that this is the entire agreement between The Company and myself on the subject of discharge, termination, and/or layoff, and that this agreement may be changed only by an agreement in writing signed by the President of the Company and addressed specifically to me.

2. I further recognize that if employed by the Company, I agree, in partial consideration of my employment, to file a demand for arbitration to resolve any disputes arising from my employment, as required under Paragraph 7 below.  I agree to file such demand within six (6) months after the claim arises or within the applicable statutory limitation period(s) provided by law, whichever occurs first.

3. I hereby release all third parties who provide information to the Company with or without notice to me, from any and all liability for the transmittal of any information bearing on my histories or qualifications, in connection with any such request.  I further authorize and release the Company from all liability for forwarding to any other entity to which I may apply for employment, any information concerning histories and/or my qualifications or me as the Company has at the time of my application for employment or hereafter acquires.  I further release from all liability any and all third parties for any statements made or any actions taken in connection with this application or any other applications made simultaneously herewith, or in connection with any other form of review of my histories or qualifications. I hereby waive on behalf of the Company any and all third parties any and all notice(s) I would otherwise be entitled to receive by law in connection with any reference check.

4. I will hold in strictest of confidence and will not disclose directly or indirectly to any unauthorized persons, without the Company's prior written permission, at any time during or subsequent to my employment, any knowledge not already available to the public, respecting the inventions or respecting the designs, methods, systems, improvements, trade secrets, production techniques, processes, sales promotions and ideas, customer lists or other confidential matters of the Company.

5. I understand that if I have a disability I must timely tell you in writing of my need for accommodation after I know or reasonably should know that an accommodation is needed. I further understand failure to do so will prevent me from alleging a violation of the accommodation requirements imposed by law.

6. I certify that all information submitted by me in this application is true, complete and correct and understand that if any such information is found to be misrepresented, omitted or otherwise incorrect, it may result in discharge from employment

7. ANY DISPUTE ARISING OUT OF OR IN CONNECTION WITH ANY ASPECT OF MY EMPLOYMENT OR ANY TERMINATION THEREOF (INCLUDING BY WAY OF EXAMPLE BUT NOT LIMITATION, DISPUTES CONCERNING ALLEGED CIVIL RIGHTS VIOLATONS, EMPLOYMENT DISCRIMINATION OF ANY KIND INCLUDING ON THE BASIS OF ANY PROTECTED CATEGORY UNDER FEDERAL OR STATE LAW, RETALIATION, WRONGFUL DISCHARGE, ENTITLMENT TO OVERTIME PAY, SEXUAL HARRASMENT BREACH OF EXPRESED OR IMPLIED CONTRACT OR TORT), SHALL BE EXCLUSIVELY SUBJECT TO BINDING ARBITRATION UNDER THE NATIONAL RULES FOR THE RESOLUTION OF EMPLOYMENT DISPUTE OF THE AMERICAN ARBITRATION ASSOCIATION ("AAA"), provided all substantive rights and remedies including any applicable damages provided under pertinent statue(s) related to such claims, the right to representation by counsel, a neutral arbitrator, a reasonable opportunity for discovery, a fair arbitral hearing, a written arbitral award containing findings of facts and conclusions of law, and any other provisions required by law, shall be available in the AAA forum. Any decision of the Arbitrator shall be final and binding as to both parties, and enforceable by any court of competent jurisdiction.  Nothing containing herein shall prohibit me from filing any claims or charges with any appropriate government agency.

   I UNDERSTAND THAT MY AGREEMENT HEREIN CONSTITUTES A WAIVER OF MY RIGHT TO ADJUDICATE CLAIMS AGAINST THE COMPANY IN COURT, AND THAT I AM OPTING INSTEAD TO ARBITRATE ANY SUCH CLAIMS.

8. In the event that one or more provisions of this application are declared void, the balance of the provisions shall remain in force.