Job Application

Personal Info


Contact Info


Driver's License

Employment Desired


Employment Record

Employer 1

From Date
To Date
Contact Person

Employer 2

From Date
To Date
Contact Person

Employer 3

From Date
To Date
Contact Person

Employer 4

From Date
To Date
Contact Person

Military Service

Professional References

Do NOT include relatives.

Reference 1

Reference 2

Reference 3


Applicant's Statement

I understand that the employer follows an “employment at will” policy, in that I or the employer may terminate my employment at any time, or for any reason consistent with applicable state or federal law; this “employment at will” policy cannot be changed verbally or in writing, unless the change is specifically authorized in writing by the chief operating officer of this organization. I understand that this application is not a contract of employment. I understand that federal law prohibits the employment of unauthorized aliens; all persons hired must submit satisfactory proof of employment authorization and identity; failure to submit such proof will result in denial of employment.

I understand this application will be active for a period of one year; after that time, if I wish to be considered for employment, I must submit a new application.

I understand that the employer will thoroughly investigate my work and personal history and verify all data given on this application, or related papers, and in interviews. I authorize all individuals, schools, and firms named therein, except my current employer if so noted, to provide any information requested about me, and I release them from all liability for damage in providing this information.

I certify that all the statements herein are true and understand that any falsification or willful omission shall be sufficient cause for dismissal or refusal of employment.

Under penalty of perjury, I affirm that the information provided is correct to my knowledge and hereby offer my legally-binding digital signature.