Name*

First NameLast Name

Phone Number*

Area CodePhone Number

E-mail Address*

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

How were you referred to us?*

Which position are you applying for?*

Type of employment desired

Full-timePart-timeTemporarySummer

Upload Resume*

Upload a File

Upload Cover Letter*

Upload a File

Training or Certifications

Upon hiring, all persons must verify eligibility to be employed in the United States. Are you a United States citizen or legally authorized to work in the United States?*

YesNo

Do you have any relatives or friends working for this company?

YesNoOther

Have you ever worked for this company before?

YesNoOther

References

Please list three (3) references that are familiar with your work life. At least one must be a current or former supervisor.

Reference 1

Name*

First NameLast Name

Phone Number*

Area CodePhone Number

Email*

example@example.com

Years Known*

Relationship to Applicant*

Reference 2

Name*

First NameLast Name

Phone Number*

Area CodePhone Number

Email*

example@example.com

Years Known*

Relationship to Applicant*

Reference 3

Name*

First NameLast Name

Phone Number*

Area CodePhone Number

Email*

example@example.com

Years Known*

Relationship to Applicant*

Date available to begin work

Date

Release & Consent

I understand and certify that all information supplied in this application, and any attached resume, is complete and correct. Any false, misleading or incomplete information furnished by me regarding this application may result in the rejection of this application or if employed, dismissal. I understand that in consideration of my employment, I agree to conform to the rules and regulations of the Employer, and further agree that my employment and compensation are at the will of the Employer and can be terminated, with or without cause, and with or without notice, at any time at the option of either the Employer or myself. I understand and agree that these terms can only be modified in writing and signed by the Executive Director/CEO. No supervisor, representative, agent, or other employee of the Employer has now or has had in the past the authority to enter into any agreement for employment, or to make any agreement which is contrary to or in modification of the above terms, nor can any policies or practices of the Employer either written or oral, modify the above terms.

I understand and agree to take any physical examination and pre-employment test, including drug screening test. All such tests will be administered in compliance with the Americans with Disabilities Act.

I understand and hereby authorize all persons, schools, companies, employers, and/or their representatives to furnish verification to the Employer, its representatives or agents, any and all information set forth in this application and/or attached resume. In addition, I hereby agree to hold harmless and to release from all liability all said persons, schools, companies, employers and/or their representatives from any and all claims that I may have, or which may arise, against any and/or all of them, including the Employer, as a result of them furnishing information to the Employer. I authorize the Employer, should they employ me, to release employment references if my employment becomes terminated for any reason. I also authorize the Employer to conduct credit, police, criminal and driving record inquiries, or any other employment related inquiries in compliance with the provisions of the Fair Credit Reporting Act, 15 U.S.C. Section 1681, et. seq. I understand that the decision to hire me and my continued employment will be subject to the results of these inquiries.

We consider applicants for all positions on the basis of qualifications and without regard to race, color, religion, gender (sex), national origin, age, marital status, veteran status, disability, sexual orientation, use of lawful products during non-work hours and any other legally protected status.

I understand this application will be active for employment consideration for 30 days. After 30 days, if I wish to be considered for employment, I must contact the Employer to determine if applications are being accepted.

I have read, understand and agree with this statement.

I agree that by using the e-signature feature on this website I am applying my electronic signature which is the legally binding equivalent to my handwritten signature. Whenever I execute an electronic signature, it has the same validity and meaning as my handwritten signature. I also agree that no certification authority or other third party verification is necessary to validate my e-signature.*

Full Name

Signature