Employment Application

Personal Data

Are you:

Work Experience

Note: Start with most recent position, furnish dates and explanations for each period of unemployment of one month or more.

A resume providing this information may be attached as a supplement; however these fields are required.

Additional Professional Information (if applicable)
Before Work Experience

Please complete all appropriate items:

Other Achievements and Activities

Note: Please list honors, scholarships, or fellowships; memberships in academic honorary or professional societies; specialty certification or training programs completed, or participation in or offices held in extracurricular activities you consider significant. (Exclude those indicating race, color, religion, national origin or any other protected characteristic.)

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If you have any questions regarding the following statements, please ask them of an employment interviewer before signing.

This Firm does not discriminate in hiring or employment on the basis of race, color, religion, sex, national origin, age, handicap, veteran status, or status within any other protected group. No questions on this application are intended to secure information to be used for such discrimination. This application will be given every consideration, but our receipt of it does not imply that you will be offered employment.

In processing this employment application, this Firm may request a background check, including, but not limited to, a police and/or credit report about you. You have the right to request this Firm to completely and accurately disclose to you the content of those reports. Additional information concerning the use of these reports, your rights relating thereto and documenting your authorization for the Firm to receive such reports shall be provided to you under separate cover.

By signing your name below, you certify that all statements made by you on this application are true and complete to the best of your knowledge and that you understand that misrepresentations or omissions may be cause for rejection, or may be cause for subsequent dismissal if you are hired.

By signing your name below, you understand that nothing contained in this application or in the interview process is intended to create an employment contract between the Firm and you. Should this application result in your employment, you have a right to terminate your employment at anytime and for any reason and the Firm retains a similar right. You further understand that no representative of the Firm, except for the Director of Human Resources, has the authority to enter into any agreement with you for any specified period of time or to guarantee some other personnel move or benefit. You further understand that any such agreement must be in writing and signed by the Director of Human Resources. You further understand this entire statement applies to the period prior to or after you may be employed.

By signing your name below you give the Firm the right to contact and obtain information from all references, employers, educational institutions and to otherwise verify the accuracy of the information contained in this application. I hereby release from liability the Firm and its representatives for seeking, gathering, and using such information and all other persons, corporations or organizations for furnishing such information.

I hereby acknowledge that I have read and understand each of the above statements.