APPLICATION FOR EMPLOYMENT Position(s) Applied for:First Name *Last Name *Primary Phone *Email Address *Street Address *Apt #City *State *ZIP *Are you currently employed?YESNOHave you been convicted of a felony in the last five years?YESNOAre you authorized to work in the United States?YESNODate available for workExpected Wage or SalaryWhat's your availability? Check all that apply.Part TimeFull TimeFirst ShiftSecond ShiftThird ShiftEDUCATION INFORMATIONEDUCATIONName and Address of High SchoolDiploma/GED?Certifications or Other (examples: welding certificate, CNC Certification, etc.PRIOR WORK HISTORYWORK HISTORY (Start with your most recent employer.)DATESFROM:TO:RATE OF PAYSTART:FINISH:EMPLOYERNAME:CITY:DESCRIBE THE WORK YOU DID:WHAT WAS YOUR REASON FOR LEAVING?DATESFROM:TO:RATE OF PAYSTART:FINISH:EMPLOYERNAME:CITY:DESCRIBE THE WORK YOU DID:WHAT WAS YOUR REASON FOR LEAVING?DATESFROM:TO:RATE OF PAYSTART:FINISH:EMPLOYERNAME:CITY:DESCRIBE THE WORK YOU DID:WHAT WAS YOUR REASON FOR LEAVING?ADDITIONAL INFORMATIONADDITIONAL INFORMATIONHave you served in the Armed Forces?YESNOIf yes, what branch?Rank at discharge?DATES OF DUTY:FROM:TO:State any additional information you feel may be helpful to us in considering your application, including any job related training in the U.S. Military (special training and duty stations) or other employers.PRE-EMPLOYMENT DRUG/ALCOHOL SCREEN WAIVER AND CONSENT. Having been advised that a drug/alcohol screen will be part of my pre-employment evaluation process, I hereby authorize its physicians, nurses, technicians, and/or company representatives to receive samples of my urine, breath and/or oral fluids for the purpose of determining their content and the presence of any alcohol or illegal drug. I understand and agree that the results of this test will be disclosed to the Company, and I hereby release the testing laboratory, the Company and any of their employees or agents from any and all claims or causes of action resulting from the disclosure of these results. Further, I hereby waive any patient-client privilege that may otherwise exist with respect to the confidentiality of these results and these tests. PLEASE READ CAREFULLY APPLICANT’S CERTIFICATION AND AGREEMENT. I hereby certify answers given herein are true and complete. I authorize investigation of all statements contained in this application for employment as may be necessary in arriving at the employment decision. This application for employment shall be considered active for a period of time not to exceed six (6) months. Any applicant wishing to be considered for employment beyond this time period should inquire as to whether or not applications are being accepted at that time. I understand and agree that the Company has no obligation to employ me, and that any offer of employment is revocable by the Company at will and contingent on completion of any background check and any post-offer medical examination, as well as on drug-test results. I understand and agree that, if hired, I will conform to the rules and regulations of the Company. I understand and agree that if hired my employment may be terminated by either me or the Company at will at any time, with or without notice or cause. I understand and agree that no representative of the Company, other than the President, by a written agreement for a specific term signed by both the employee and the President, has any authority to enter into any agreement for employment for any specified period of time or to restrict the Company's right to terminate employment at will in any way. I agree that any action or lawsuit that arises out of or relates to my application for employment, my employment with the Company, or any termination of my employment, must be filed no later than six months after the date of the event giving rise to the claim on which the action or lawsuit is based, or the claim will be barred. While I understand that the normal statute of limitations for claims arising out of an employment action may be longer than six (6) months, I agree to be bound by the shorter six (6) month period of limitations set forth above and I WAIVE ANY STATUTE OF LIMITATIONS TO THE CONTRARY, except that this waiver does not apply to a claim based on a statute under which the period to bring a claim cannot lawfully be shortened by a contract or agreement. In the event of employment, I understand that false or misleading information given in my application or interview(s) may result in discharge.ConsentI understand that by placing my name in the SIGNATURE box below and submitting this form, I am agreeing with the PRE-EMPLOYMENT DRUG/ALCOHOL SCREEN WAIVER AND CONSENT.SIGNATURE (FULL NAME) *DATE *SUBMITPlease do not fill in this field.