Application for Employment

Employment decisions are made without regard to race, ancestry, color, sex, national origin, religion, marital status, age or non-job-related disability.

Personal Information

Contact Info
Present Address

Employment Desired

Current Employment

Are you employed now?
If so, may we inquire of your present employer?
Current Employer

Driving Information

If yes, please explain where, when, and for what reason

Criminal Conviction

Please list any criminal convictions for felonies or misdemeanors sustained within the last 10 years. You will not be automatically excluded from consideration if you have been convicted of a crime. Your suitability for the position sought will be evaluated based upon the totality of circumstances, such as: the nature of the crime, the frequency of the conviction, the type of work involved, etc


High School
University / College / Trade School
Other Education


List below last four employers, starting with the most recent

Most Recent Employer

Date of Employment

Second Most Recent Employer

Date of Employment

Third Most Recent Employer

Date of Employment

Fourth Most Recent Employer

Date of Employment


Give below the names of three persons not related to you, whom you have known at least one year.

1st Reference

2nd Reference

3rd Reference

In submitting this application for employment, I authorize investigation of all statements contained in it, and it is understood and agreed that any misrepresentation by me in this application may result in cancellation of the application and/or separation from the company's service if I have been employed. If I am offered employment, I understand that I may be required to pass a medical examination as a condition of employment and if so I consent to release any and all medical information during this examination as may be deemed necessary by the company.
In consideration of any employment I agree to conform to the rules and regulations of the company. My employment and compensation can be terminated, with or without cause, and with or without notice, at any time, at the opinion of either the company or myself. I understand that no representative of the company except the General Manager has any authority to enter into any agreement for any specified time or to make any agreement contrary to the foregoing.

I certify I have read all of this application and that the information I have provided above is true and correct.