Contact Information

Are you 18 years old or older?

—Please choose an option—YesNo

Are you authorized to work in the U.S.?

—Please choose an option—YesNo

Present Address:

City:

State:

Zip:

Telephone Number:

Alternate/Cell Phone Number:

Email:

Employment Information

Salary Desired:

Date Available to Start:

Are you currently employed?

—Please choose an option—YesNo

May we contact your present employer?

—Please choose an option—YesNo

Are you on a layoff status and subject to recall?

—Please choose an option—YesNo

Important: Please give the name and address of last three employers:

Address:

City:

State:

Zip:

Type of Work:

Start Date:

End Date:

Wages:

Employer 2:

Address:

City:

State:

Zip:

Type of Work:

Start Date:

End Date:

Wages:

Employer 3:

Address:

City:

State:

Zip:

Type of Work:

Start Date:

End Date:

Wages:

Please explain any gaps of employment:

Background Information

Last grade completed:

Military Service:

Have you ever been convicted or pled guilty or no contest to any criminal offense?
(Criminal convictions are not an automatic bar from employment but will only be considered in relation to specific job requirements.)

—Please choose an option—YesNo

If yes, please explain:

If the position requires travel, are you able?

—Please choose an option—YesNo

Do you have a California driver's license?

—Please choose an option—YesNo

Will you abide by the safety rules of this company:

—Please choose an option—YesNo

Have you ever been terminated from employment?

—Please choose an option—YesNo

If yes, please explain:

References:

Phone/Address:

Position:

Years Known:

Reference 2 Name:

Phone/Address:

Position:

Years Known:

Reference 3 Name:

Phone/Address:

Position:

Years Known:

ADDITIONAL TERMS AND CONDITIONS:

Please check each box to accept the conditions outlined below.

I certify that the answers given by me to the foregoing questions and statements on the employment application and/or during the employment interview process are true and correct without any consequential omissions of any kind whatsoever. I understand that any misleading or incorrect statements may render this application void and, if employed, would be cause for my termination. I further agree that the Company shall not be liable in any respect if my employment is terminated because of falsity of statements, answers or omissions made by me in this application.

I understand that this application is designed for use with several types of jobs and some questions may not be completely applicable to the position for which I am applying.

I authorize the companies, schools, persons or entities given during the employment process, and the employer (if employed), while employed, or during internal investigations, as references or' past employers or affiliations, to give any information regarding my employment, character, qualifications, certifications and licenses, and hereby release said companies, schools, persons or entities from all liability for any damage for issuing this information. A favorable result may be a condition of employment, commencement, or continuation of any employment duties where elements are job-related.

I understand that a background check may be conducted during the employment process and that if employed, a background check may be conducted periodically as deemed necessary by the employer.

I understand that a credit check may be conducted during the employment process and that if employed, a background check may be conducted periodically as deemed necessary by the employer.

I understand that I may be required to have a medical examination and/or drug and alcohol test after an offer of employment has been made and prior to the commencement of my employment duties as well as any time throughout my employment according to company policy. A favorable result on the medical examination and/or drug and alcohol test would be a condition of my employment or commencement of any employment duties.

I realize that operating conditions may require me to work shifts or work hours scheduled other than the one for which I am applying and I agree to such scheduling change as directed by my supervisor or the management.

I understand that my employment is not for a specified or definite term and that I may resign, or I may be discharged at any time, for any reason, with or without good cause and with or without prior notice. I further understand that this policy cannot be changed or amended except by written agreement signed by me and by a corporate officer. I understand that this is an application for employment and that no employment contract is being offered.

I understand that only United States citizens or aliens who are legally entitled to work in the United States are eligible for employment.

My employment shall be in accordance with the terms of this application, all safety and incident reporting rules, and all other Company rules and regulations. The Company shall have the right to amend, modify, or revoke its rules and regulations at any time. I will familiarize myself promptly with such rules and regulations and will be bound by the rules and regulations now or hereafter in effect.

I certify that as part of the application process, I have been provided with a written job description or have had the
opportunity to review and/or discuss the requirements for the position for which I am applying. I certify that I understand each requirement and that I am capable of meeting each and every requirement.

I have read and accept the conditions outlined above.

Today's Date: