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  • Personal Information

  • Education

  • Employment History

  • Please give accurate, complete employment data, including part-time employment. Start with your present or most recent employer. You may include any verified work performed on a volunteer basis, licensing certifications, and/or specialized training. If applicable, include relevant military experience. In addition to answering these questions, please feel free to attach your resume, but not in place of completing the required information.
  • Month/Year to Month/Year
  • Month/Year to Month/Year
  • References

  • Please list 3 professional references that can verify your work history and performance such as former co-workers or former managers.
  • Please include name and title of reference, company name and address, company phone number.
  • Please include name and title of reference, company name and address, company phone number.
  • Please include name and title of reference, company name and address, company phone number.
  • Please read carefully before submitting: I certify that the above information is true, complete, and correct to the best of my knowledge. I represent that I have withheld nothing which, if disclosed, would affect this application unfavorably. I understand that any false statement, misrepresentation or omission made by me on my application, resume, or any other materials I have submitted, or during my interviews, can result in denial of employment, or, if I am already employed when such false statement, misrepresentation or omission is discovered, immediate termination of my employment. I authorize the Company to inquire into my educational, professional and past employment history references as needed to research my qualifications for this position. I hereby give my consent to any former employer, educational institution, or individual listed as a reference in this application to provide information about me to the Company, and I agree to hold the Company and any such former employer, educational institution, or individual harmless from any claims made by me on the basis of providing such information. I further agree that the Company and any such former employer, educational institution, or individual shall not be held liable in any respect if a job offer is not extended or is withdrawn by the Company, or if my employment is terminated due to information provided in response to this application. I understand that the Immigration Reform and Control Act of 1986 requires that, if hired, I must furnish appropriate documentation to the Company establishing my identity and employment eligibility. If offered a position by the Company, I agree to provide the Company documents which verify my identity and right to work in the United States within 72 hours of commencing employment as a condition of my employment. I understand that employment at the Company is terminable “at will,” which means that the employment relationship can be terminated by either me or the Company at any time and for any reason not prohibited by law. I understand that nothing in this employment application, the granting of an interview for employment, any offer of employment, nor any personnel manuals or forms used by the Company create an employment contract between myself and the Company. I further understand that no supervisor, manager or representative of the Company other than the President/CEO and CFO has any authority to enter into any agreement for employment for any specified period of time. In the event of my employment with the Company, I agree to comply with all Company rules and regulations. I further understand that I may be required to sign a confidentiality, business ethics and/or non-competition agreement in connection with any employment with the Company. I hereby acknowledge that I have read and agree to the above statements.
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