employment (include military service, e.g. branch, rank, and dates of duty, to the extent relevant to the position for which you are applying)
please provide 3 professional and/or techincal references
educational and special training background
special training, skills, experience
if yes, please provide the information below
(note: no applicant will be denied employment solely on the grounds of conviction or a criminal offense. The nature, date, surrounding circumstances and relevance of the offense to the position for which you are applying will be taken int consideration. False information could be grounds for termination)
certification and agreement
I hereby certify that the facts I have communicated to this company connection with my prospective employment are true and complete to the best of my knowledge and I authorize this company and/or such outside investigative agency to conduct a background investigation and agree to cooperate fully in it.
I hereby release this company and all persons or organizations supplying information from any/all liability of whatever kind and nature which, at any time, could result from obtaining and having an employment decision based on such information.
I understand that any misrepresentations, omissions of facts communicated to this company could disqualify me from further consideration for employment. I further understand that, if employed, any misrepresentations or omissions of facts in any will be cause for my dismissal at any time without prior notice.
I understand that should an employment offer be extended to me and accepted that I will fully adhere to the policies, rules and regulations of employment with this company. However, I further understand that neither the policies, rules, regulations of employment nor anything said during the interview process shall be deemed to constitute the terms of an implied employment contract.
I also understand that if I am hired, I will be required to provide proof of identity and legal authorization to work in the United States and that I will be required to complete a federal government Form I-9 in this regard.
This application does not constitute, and may not be construed as, a commitment to employment for any specific duration. Employment with this company will be at will, which means that you may leave employment or the employer may require that you leave its employ for any reason, at any time. I acknowledge that I have not relied on any representations or statements, whether oral or written, regarding employment with this company, other than those contained in this paragraph.
ALL APPLICANTS WILL BE GIVEN EQUAL CONSIDERATION REGARDLESS OF RACE, COLOR, SEX, RELIGION, AGE, NATIONAL ORIGIN, DISABILITY, SEXUAL ORIENTATION, VETERAN, MARITAL OR CITIZEN STATUS, PREGNANCY, GENETIC INFORMATION, OR OTHER FEDERAL, STATE, OR LOCAL LEGALLY PROSCRIBED CRITERIA.
AN EQUAL OPPORTUNITY EMPLOYER