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Employment application

Equal access to programs, services and employment is available to all persons. Those applicants requiring reasonable accommodation to the application and/or interview process should notify a representative of the Human Resources Department.
 
 
 
 
Source of Referral
 
Type of Employment Desired
Educational Co-op:
 
Yes
No
Yes
No
 
 
Yes
No
Yes
No
Yes
No
Yes
No
 
Yes
No
Yes
No
Answering "yes" to these questions does not constitute an automatic bar to employment, factors such as the date
of the offense, seriousness and nature of the violation, rehabilitation and position applied for will be taken into account.
 
EMPLOYMENT HISTORY
Starting with PRESENT or MOST RECENT, list all previous employers. Include self-employment, summer and part-time jobs.
 
 
 
 
EDUCATIONAL BACKGROUND
List the three (3) schools attended, starting with the most recent.
 
 
 
 
REFERENCES
 
 
 
 
ADDITIONAL INFORMATION
List professional, trade, business or civic associations and any offices held. Exclude memberships that would
reveal race, color, religion, sex, national origin, citizenship, age, mental or physical disabilities, veteran/reserve
national guard or any other similarly protected status.
 
 
 
 
List any accomplishments, publications, awards, etc. Exclude memberships that would reveal race, color, religion, sex,
national origin, citizenship, age, mental or physical disabilities, veteran/reserve national guard or any similarly protected
status:
 
List any information you would like us to consider:

Application Statement

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

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 (II) immediately discharge me from the
employer's service, whenever it is discovered.

I expressly authorize, without reservation, the employer, its representatives, employees or agents to contact and obtain
information from all references (personal and professional), 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. I 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.

I 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 only 30 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.

If 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 right 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 specified period or definite duration. I understand that no supervisor or representative of the employer is
authorized to make any assurances to the contrary and that no implied oral or written agreements contrary to the
foregoing express language are valid unless they are in writing and signed by the employer's president.

I 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 and I-9 Form in this regard.

AGREEMENT

I do hereby certify and agree by completion of the attached application and submission via email, that SYSTELĀ® may
conduct testing which may be necessary for approval of hiring which shall include, but not limited to credit inquiries, drug
testing, and a driving record inquiry.

Do not submit until you have read the above Applicant Statement.


I certify that I have read, fully understand and accept all terms of the foregoing Applicant Statement

 

 

 
 
   
 

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