Online Application

CAUTION - READ CAREFULLY BEFORE COMPLETING

My signature below authorizes the Employer to conduct a background investigation and authorizes release of information in connection with my application for employment. This investigation may include such information as criminal or civil convictions, driving records, previous employers and educational institutions, personal references, professional references and other appropriate sources. I waive my right of access to any such information and, without limitation, hereby release the Employer and the reference source from any liability in connection with its release or use. This release includes the sources cited above and specific examples as follows: law enforcement organizations, information from the central criminal records exchange or either data on all criminal convictions or certification that no data on criminal convictions are existent.

I agree to voluntarily undertake a physical examination (which may or may not include a psychological examination) and drug/alcohol testing as a condition of continued employment. I understand that the results of such examination and/or testing may be legitimate basis for my immediate termination. I release the Employer and any medical personnel or institution or any approved testing facility in connection with the physical examination or drug/alcohol testing to which I voluntarily submit.

Furthermore, I certify that I have made true, correct and complete answers and statements on this application and the knowledge that they may be relied upon in considering my application. I understand that any omission, false answered statement made by me on this application, or any supplement to it will be sufficient grounds for failure to employ or for my discharge should I become employed with the employer.

Applicant Use Only

I. Educational and Vocational Training (List Chronologically):

High School

College or University

Other

II. Work Experience (List Chronologically)

III. Military Experience

IV. General Information

V. References

It is the applicant's responsibility to have the following information provided to the Employer in order to be considered for employment.

The names of at least three reference sources must be provided and must include current employer if employed, or last employer if not currently employed.