December 3, 2021
SAFETY & RISK MGMT
Online Employment Application
Incomplete applications will not be processed. This application will be considered active for 180 days. Any applicant wishing to be considered beyond this time period should submit another application.
This application is intended for use in evaluating your qualifications for employment. This is not an employment contract. Please answer all questions completely and accurately. False or misleading statements on this form are grounds for terminating the application process, or, if discovered after employment, terminating employment. Additional testing of job-related skills or for the presence of illegal drugs in your body may be required prior to employment.
First Name *
Last Name *
Zip Code *
Which position are you interested in?
Willing to relocate?
Full-Time or Part-Time employment?
If Part-Time, how many hours per week are you available?
What date are you available to start?
Are you at least 18 years of age?
Are you prevented from being lawfully employed in this country due to a Visa or immigration status?
High School Name
Receive High School Diploma?
How many years of College have you completed?
What is/was your course of study?
What was your graduation date/projected graduation date?
Please list all other Schooling:
Job Related Skills
List any languages other than English that you speak fluently:
Mark all skills that apply:
10 Key Adding Machine
List all knowledge of computer programs:
List any other skills:
List any licenses or certifications you have that you feel would be of value to this job or company
Have you ever been bonded in prior employment?
Have you ever been convicted of a misdemeanor or a felony?
No If Yes, please explain
If I am interviewed and accept employment, I agree to allow company to investigate my background.
Please go back 5 years, listing your most recent employer first. Include any gaps in employment and state the reason for no employment during that period.
Reason for Leaving
Reason For Leaving
Reason for Leaving
Include only individuals familiar with your work ability. Do not include relatives. Please do not include individuals to whom you directly reported in the last five years.
Name, Address, Phone:
# Years Known
* = Required Field
I hereby certify that I have a genuine interest in being hired and that all of the foregoing statements are true and correct. I agree to assume a continuing responsibility to disclose additional or new information, called for by this Employment Application, but known to me only after this Application was completed, and understand that my failure to make such a disclosure, and that falsification of any of the information given herein, on any employment form or in any interview, are grounds for immediate termination, regardless of when such failure or falsification may be discovered.
I also understand that my employment may be terminated at any time, with or without cause, without liability to me for salary, wages, or other benefits except as may have been earned up to date of the termination of services.
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