Job Application Form

First Name

Last Name

Date Of Birth

Street Line

City

State

Zip-Code

Phone No.

Start Date

Positions Available

Full-Time / Part-Time

Full-Time Part-Time

Are You Currently Employed

Yes No

Are You Currently Attending School

Yes No

Valid Driver's License / State ID

Yes No

Social Security Card

Driver's License / State ID (FRONT)

Driver's License / State ID (BACK)

APPLICANT STATEMENT

l certify that all of the information I have provided in order to apply for and secure work with the employer is true, complete and correct.

l expressly authorize, without reservation, the employer, its representatives, employees or agents to contact and obtain information from all references, employers, public agencies, licensing authorities and educational institutions and to otherwise verify the accuracy of all information provided by me in this application, resume, or job interview.

l hereby waive any and all rights and claims I may have regarding the employer, its agents, employees or representatives, for seeking, gathering and using such information in the employment process and all other persons, corporations or organizations for furnishing such information about me.

l understand that the employer does not unlawfully discriminate in employment and no question on this application is used for the purpose of limiting or excusing any applicant from consideration for employment on a basis prohibited by applicable local, state or federal law.

I understand that this application remains current for 90 days. At the conclusion of that time, if I have not heard from the employer and still wish to be considered for employment, it will be necessary to reapply and fill out a new application.

lf I am hired, I understand that I am free to resign at any time, with or without cause and without prior notice, and the employer reserves the same rights to terminate my employment at any time, with or without cause and without prior notice, except as may be required by law. This application does not constitute an agreement or contract for employment for any specific period or defined duration.

l understand that no supervisor or representative of the employer is authorized to make any assurance to the contrary and that no implied, oral or written agreements contrary to the foregoing expressed language are valid unless they are in writing and signed by the employer's president.

l also understand that if I am hired, I will be required to provide proof of identity and legal authority to work in the United States and that federal immigration laws require me to complete an I-9 Form in this regard.

I understand that any information provided by me that is found to be false, incomplete or misrepresented in any respect will be sufficient cause to (i) cancel further consideration of this application, or (in) immediately discharge me from the employer's service whenever it is discovered.

By entering my full name below, I certify that I have read, fully understand and accept all terms of the foregoing Applicant Statement

FULL NAME