1. (check all that apply)



  4. High School

  5. College/University

  6. Business/Technical

  7. Additional




  11. List two personal references who are not relatives or former supervisors.


  13. In case of accident or illness, please contact:


  15. As part of our procedure for processing your employment application, your personal and employment references may be checked. If you have misrepresented or omitted any facts on this application, and are subsequently hired, you may be discharged from your job. You may make a written request for information derived from the checking of your references.

  16. If necessary for employment, you may be required to: supply your birth certificate or the proof of authorization to work in the United States, have a physical examination and/or drug test, or sign a conflict of interest agreement and abide by its terms.

  17. Equal Employment Opportunity

  18. While many employers are required by Federal law to have an Affirmative Action Program, all employers are required to provide equal employment opportunity and may ask your national origin, race and sex for planning and reporting purposes only. This information is optional and failure to provide it will have no affect on your application for employment.

  19. Informed Consent
    1. We do not hire everyone who applies.
    2. We may or may not contact you for an interview, today or some other day.
    3. We do not always make hiring decisions instantly. Depending upon the number of applicants, decisions may take several business days.
    4. Hiring decisions are based on a number of factors. We do not discuss the reasons for our hiring decisions with applicants, regardless of whether or not they are hired.
    5. We will contact you if we have a job for you.
    6. We are an Equal Opportunity Employer. The race, color, age, national origin, gender, religion, genetic information and/or qualified disability of an applicant does not play a role in the hiring process.
    7. You agree to keep the contents of this assessment confidential and will not share the assessment questions with anyone.

  20. I have read, understand and agree to comply with these policies. I affirm that the information I provide about myself in my resume, on application forms, on surveys or assessments, and during interviews is true and correct. I understand that the information I provide will be used in hiring decisions. I consent to my information being used for this purpose.

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