CAREERS APPLY TO JOIN THE TEAM Date MM slash DD slash YYYY Name* First Middle Last Address* Street Address City State Zip Code How Long Have You Lived at Your Current Address?* Phone*Alternate Phone If Under 18, Please List Age Have You Ever Applied for Employment With Us?* Yes No If So, When?* MM slash DD slash YYYY Can you obtain a Sheriff’s Card by passing a background check?* Yes No Position Applying For* Salary Desired Please List Days/Hours Available to WorkHow Many Hours Can Your Work Weekly? Are You Willing to Work Overtime? Yes No Can You Work Nights? Yes No Employment Desired Full-time Only Part-time Only Full-or Part-time Date Available to Start* MM slash DD slash YYYY SchoolingType of SchoolNumber of Years CompletedMajor/Degree Have You Ever Been Convicted of a Crime? Yes No If yes, explain number of conviction(s), nature of offense(s) leading to conviction(s), how recently such offense(s) was/were committed, sentence(s) imposed, and type(s) of rehabilitation:*Do You Have a Driver's License & Reliable Means of Transportation? Yes No License Number State of Issue License TypeOperatorCommercial (CDL)ChauffeurDate of Expiration MM slash DD slash YYYY Have You Had Any Accidents in the Past Three Years? Yes No How Many? Have You Had Any Moving Violations in the Past Three Years? Yes No How Many? Please List Any Additional Special Training or Skills Applicable to the PositionPlease list two references other than relatives or previous employersNameRelationshipCompany/PositionPhone Number Have You Ever Been in the Military? Yes No Are You Now a Member of the National Guard Yes No Specialty Date Entered MM slash DD slash YYYY Date Discharged MM slash DD slash YYYY Work ExperiencePlease list your work experience for the past five years beginning with your most recent job held. If you were self-employed, give the firm name.Name of Employer Phone NumberName of Last Supervisor From MM slash DD slash YYYY To MM slash DD slash YYYY Pay Your Job Title Reason for LeavingList the jobs you held, duties performed, skills used or learned, advancements or promotions while you worked at this companyAdd a 2nd Employer? Yes No Name of Employer Phone NumberName of Last Supervisor From MM slash DD slash YYYY To MM slash DD slash YYYY Pay Your Job Title Reason for LeavingList the jobs you held, duties performed, skills used or learned, advancements or promotions while you worked at this companyAdd a 3rd Employer? Yes No Name of Employer Phone NumberName of Last Supervisor From MM slash DD slash YYYY To MM slash DD slash YYYY Pay Your Job Title Reason for LeavingList the jobs you held, duties performed, skills used or learned, advancements or promotions while you worked at this companyMay We Contact Your Present Employer? Yes No Did You Complete This Application Yourself? Yes No If not, who did? Please Read Carefully In exchange for the consideration of my job application by (hereinafter called "the Company"), I agree that: Neither the acceptance of this application nor the subsequent entry into any type of employment relationship, either in the position applied for or any other position, and regardless of the contents of employee handbooks, personnel manuals, benefit plans, policy statements, and the like as they may exist from time to time, or other Company practices, shall serve to create an actual or implied contract of employment, or to confer any right to remain an employee of , or otherwise to change in any respect the employment-at-will relationship between it and the undersigned, and that relationship cannot be altered except by a written instrument signed by the President/General Manager of the Company. Both the undersigned and , may end the employment relationship at any time, without specified notice or reason. If employed, I understand that the Company may unilaterally change or revise their benefits, policies and procedures and such changes may include reduction in benefits. I authorize investigation of all statements contained in this application. I understand that the misrepresentation or omission of facts called for is cause for dismissal at any time without any previous notice. I hereby give the Company permission to contact schools, previous employers (unless otherwise indicated), references, and others, and hereby release the Company from any liability as a result of such contract. I also understand that (1) the Company has a drug and alcohol policy that provides for pre-employment testing as well as testing after employment; (2) consent to and compliance with such policy is a condition of my employment; and (3) continued employment is based on the successful passing of testing under such policy. I further understand that continued employment may be based on the successful passing of job-related physical examinations. I further understand that my employment with the Company shall be probationary for a period of ninety (90) days, and further that at any time during the probationary period or thereafter, my employment relation with the Company is terminable at will for any reason by either party. Signature of Applicant Date MM slash DD slash YYYY This Company is an equal opportunity employer. We adhere to a policy of making employment decisions without regard to race, color, religion, sex, sexual orientation, national origin, citizenship, age or disability. We assure you that your opportunity for employment with this Company depends solely on your qualifications. Thank you for completing this application form and for your interest in our business.