Personal Information


Present Address
* Address:
* City:
* State:
* Zip:
Permanent Address
Address:
City:
State:
Zip:

Employment Desired


Education


Grammer School
School Name:
City
State
Years Completed
  • Did You Graduate?
    Yes No
    • Degree/G.P.A.
    High School
    School Name:
    City
    State
    Years Completed
  • Did You Graduate?
    Yes No
    • Degree/G.P.A.
    College
    School Name:
    City
    State
    Years Completed
  • Did You Graduate?
    Yes No
    • Degree/G.P.A.
    Other Training
    School Name:
    City
    State
    Years Completed
  • Did You Graduate?
    Yes No
    • Degree/G.P.A.

    General


    Subjects of special study or research work:
    Job related skills (typing, driver's license, etc):
    Memberships in Professional or Civic Organizations (Exclude those which my disclose your race, religion, or nationality):
    Have you been convicted of a crime in the past 10 years, excluding misdemeanors and summary offenses, which has not been annulled, expunged or sealed by a court? If "yes", describe in full:

    Work Experience

    Please list your work experience for the past 5 years starting with your most recent job held. If you were self-employed, give Firm name

    Employer Name
    Phone Number
    Location
    Position:
    Salary
    Reason for leaving
    Employer Name
    Phone Number
    Location
    Position:
    Salary
    Reason for leaving
    Employer Name
    Phone Number
    Location
    Position:
    Salary
    Reason for leaving
    Employer Name
    Phone Number
    Location
    Position:
    Salary
    Reason for leaving

    Military Experience

    Did you serve in the U.S. Armed Forces?
    Yes No
    If So, what branch?

    References

    1. Name:
    Phone Number
    Location
    Position:
    Years Aquainted
    2. Name:
    Phone Number
    Location
    Position:
    Years Aquainted
    3. Name:
    Phone Number
    Location
    Position:
    Years Aquainted

    Authorization

    If you are to be hired by the company, you will be required to attest to your identity and employment eligibility, and to present documents confirming your identity and employment eligibility. You cannot be hired if you cannot comply with these requirements.

    I certify that the facts contained in this application (and accompanying resume, if any) are true and complete to the best of my knowledge. I understand that any false statement, omission, or misrepresentation on this application is sufficient cause for refusal to hire, or dismissal if I have been employed, no matter when discovered by the Company

    I understand that any employment is conditioned on a background check. I authorize the Company to thoroughly investigate all statements contained in my application or resume, and I authorize my former employers and references to disclose information regarding my former employment, character and general reputation to the Company, without giving me prior notice of such disclosure. In addition, I release the Company, any former employers and all references listed above from any and all claims, demands, or liabilities arising out of or related to such investigation or disclosure.

    I understand and agree that nothing contained in this application, or conveyed during any interview, is intended to create an employment contract. I further understand and agree that if I am hired, my employment will be "at will" and without fixed term, and may be terminated at any time, with or without cause and without prior notice, at the option of either myself or the Company. No promises regarding employment have been made to me, and I understand that no such promise or guarantee is binding upon the Company unless made in writing.

    Johnny Janosik may require, depending upon job duties, a medical examination and if I am offered employment I agree to submit to a medical examination before starting work. If employed, I also agree to submit to a medical examination at any time deemed appropriate by the Company and as permitted by law. I consent to such examinations and tests, and I request that the examining doctor disclose to the Company the results of the examination, which results shall remain confidential and segregated from my personnel file. I understand that my employment or continued employment, to the extent permitted by law, is contingent upon satisfactory medical examinations and drug test, and if I am hired a condition of my employment will be that I abide by the Company's Drug and Alcohol Policy.

    I understand that filling out this form does not indicate there is a position open and does not obligate the Company to hire. If hired, I agree to abide by all Company work rules, policies and procedures. The Company retains the right to revise its policies or procedures, in whole or in part, at any time.

    I have read, and agree to this statement