Application for Employment

Name
Local address
Referred by

Active military service

Are you at least 16 years of age?
New York State Law Against Discrimination prohibits discrimination because of age.
Position Desired
Available weekends

Available to work until (date)

Notify in case of emergency

Education

College

Graduate

Employment

List present and past employment for last 5 years.

Past Employers

Address
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Pre-employment statement

I understand that the Company will not contact my present employer without my permission. I authorize the Company to investigate other information in this application and to consult with any other individual or organization named in this application. I authorize all named organizations to provide any information to the Company, and I release from all liability, any individual or organization providing such information. If requested, I will execute a Fair Credit Reporting Act Disclosure and Release so as to authorize the Company to obtain background report from third parties on my personal history.

I understand that if employed I am responsible for reviewing and understanding all Company policies, including the Company’s code of business conduct and ethics. I also understand that if employed I will be required, subject to applicable statutes and regulations, to work the hours (including overtime), the days (including weekends), and the shift (day or night) scheduled by the management of the department in which I am employed.

I understand that employment with the Company is at-will and that if hired my employment can be terminated with or without cause and with or without notice, at any time, at the option of either the Company or myself, and that the only person authorized to alter my at-will status is the President of the Company in writing signed by the President.

I certify that I have read and understand this PRE-EMPLOYMENT STATEMENT and that all information in this application is true and correct and without material omissions. I understand that any incorrect, incomplete or false information given by me is sufficient cause to void this application and/or terminate my employment.