Personal Information

Employment Eligibility

Education

Previous Employment

Employer #1:

Employer #2:

Employer #3:

References

Professionals Only

#1

#2

#3

Accommodations

Please read carefully, initial each paragraph and sign below.

I understand that persons employed at (“Company”) have access to confidential information regarding various phases of the Company business. Therefore, the Company requires new employees, as a condition of employment, to sign a

I understand that information concerning competitors’ operations, products, designs or other proprietary information will not be solicited from an applicant for employment, or from the Company’s employees. The Company will honor any valid post-employment restrictions contained in an applicant’s employment contract and fully respects the applicant’s duty of loyalty and non-disclosure to a former employer.

I certify that the information provided herein is correct to the best of my knowledge and belief. I am aware that failure to complete this application, intentional omissions or misstatements may result in refusal of employment or discharge. I authorize the references and contacts listed to provide you with all relevant information, personal or otherwise, and I release all parties from all liability for any damages that may result from furnishing the same to you. I understand that offers of employment may be made contingent on the receipt of a satisfactory background check and references.

In consideration of my employment, if hired, I agree to conform to the rules and regulations set forth by the Company in its policies and practices or as directed by management.

I understand that each employee of is an at-will employee unless specifically notified otherwise in writing. That is, I may terminate our employment relationship at any time, for any reason, and the Company has the same right to terminate our employment relationship at any time and for any reason. I understand that this at-will relationship cannot be modified or changed during my employment except by specific written agreement between me and the Company, signed by the President.

I understand that if offered employment, I may be required to submit to and pass a medical examination to assess my fitness for duty as a condition of beginning my employment.

I understand that if offered employment I will be required to submit to a drug and/or alcohol screen. I further understand that I must successfully pass such a screen as a condition of beginning my employment. If test results are not received until after I start employment, a positive test will result in my termination.

I understand that, if offered employment, I will be required to sign an agreement requiring me to arbitrate almost all claims I might have against in the future. I hereby agree to submit to binding arbitration all disputes and claims arising out of the submission of this application in accordance with the terms of that Agreement.

Disclaimer

Applicant understands that this is an Equal Opportunity Employer and committed to excellence through diversity. In order to ensure this application is acceptable, please print or type with the application being fully completed in order for it to be considered.

I, the Applicant, certify that my answers are true and honest to the best of my knowledge. If this application leads to my eventual employment, I understand that any false or misleading information in my application or interview may result in my employment being terminated.