Building Character, Families and Community

This Month's Trait:

Security

Structuring my life around that which cannot be destroyed or taken away.

Online Application for Employment

Please complete as much of the form as you can. However your name is required.

Basic Information
Last Name:
First Name:
Email Address:
MI:
Address:
City:
State:	ZIP:
Daytime Phone:
Alternate Phone:
18 or Older:	Yes No
Are you prevented from lawfully becoming employed in this country because of Visa or immigration status?	Yes No
Position applying for:
Date Available to Start:
Desired Salary:
This section of information does not in itself disqualify you for employment
Have you ever been convicted or pled guilty, no contest or had a suspended imposition of sentence to a crime?	Yes No
To a Felony?	Yes No
If Yes, give details:

Employment History (Including Current Employment, List Most Recent First)
From	To	Employer	Salary	Position
(MM/YY)		(Name and Address)

Reason For Leaving:
From	To	Employer	Salary	Position

Reason For Leaving:
From	To	Employer	Salary	Position

Reason For Leaving:
From	To	Employer	Salary	Position

Reason For Leaving:
May we contact your present employer? Yes No

Education and Training
Grammar School	No. Years Attended	Did You Graduate?	Subjects Studied
		Yes No
High School	No. Years Attended	Did You Graduate?	Subjects Studied
		Yes No
College	No. Years Attended	Did You Graduate?	Subjects Studied
		Yes No
Trade/Business/Other	No. Years Attended	Did You Graduate?	Subjects Studied
		Yes No
U.S. Military Service	Rank	Present Member National Guard or Reserves:

References
Give the names of three persons, not related to you, whom you have known for at least one year. Include a phone number.
Name:	Address:	Business/Phone:	Years Acquainted:




General Information
Please list special skills, activities, etc.:


"I CERTIFY THAT ALL THE INFORMATION SUBMITTED BY ME ON THIS APPLICATION IS TRUE AND COMPLETE, AND I UNDERSTAND THAT IF ANY FALSE INFORMATION, OMISSIONS, OR MISREPRESENTATIONS ARE DISCOVERED, MY APPLICATION MAY BE REJECTED AND , IF I AM EMPLOYED, MY EMPLOYMENT MAY BE TERMINATED AT ANY TIME. IN CONSIDERATION OF MY EMPLOYMENT, I AGREE TO CONFORM TO THE COMPANY'S RULES AND REGULATIONS, AND I AGREE THAT MY EMPLOYMENT AND COMPENSATION CAN BE TERMINATED WITH OR WITHOUT CAUSE, AND WITH OR WITHOUT NOTICE, AT ANY TIME, AT EITHER MY OR THE COMPANY'S OPTION. I ALSO UNDERSTAND AND AGREE THAT THE TERMS AND CONDITIONS OF MY EMPLOYMENT MAY BE CHANGED, WITH OR WITHOUT CAUSE, AND WITH OR WITHOUT NOTICE, AT ANY TIME BY THE COMPANY. I UNDERSTAND THAT NO COMPANY REPRESENTATIVE, OTHER THAN IT'S PRESIDENT, AND THEN ONLY WHEN IN WRITING AND SIGNED BY THE PRESIDENT, HAS ANY AUTHORITY TO ENTER INTO ANY AGREEMENT FOR EMPLOYMENT FOR ANY SPECIFIC PERIOD OF TIME, OR TO MAKE ANY AGREEMENT CONTRARY TO THE FOREGOING."

A Pre-Employment Drug Screening is Required

Date:	Signature:
	(Please enter email address for signature.)


To submit this form, please enter the characters you see in the image: