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Pre-Employment Application

Our organization reviews applications and employs persons without regard to race, creed, color, gender, religion, age, national origin, physical or mental disability, marital status, veterans’ status, citizenship status or any other category protected by local, state or federal law. In addition, we make reasonable accommodation to the needs of disabled applicants and employees, so long as this does not create an undue hardship on the business, or threaten the health or safety of others at work. If you need assistance in completing this application, let us know and we will provide assistance. The receipt of this application does not mean that job openings exist at our organization and does not obligate us in any way. We appreciate your interest.

I. Employee Information (Please INPUT your name EXACTLY as shown on your Social Security Card.)

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

Are you over 18 years of age? YesNo

School Print School Name, Street Address, City, State & Zip No. of Years Completed Degree Major Course of Study
High School

III. Employment Experience (Please list in chronological order beginning with your most recent employer.)




Are there any hours, shifts or days you will not, or cannot work? YesNo

Do you have any friends or relatives who work here? YesNo

IV. Professional References (Note: Listed references may be contacted.)

Have you filed an application with us before ? YesNo

Have you ever been employed here before ? YesNo

Dates (MM/DD/YYYY) Job Title Supervisor Location

NOTICE TO APPLICANTS: This employer complies with the Americans With Disabilities Act of 1990. During the interview process, you may be asked questions concerning your ability to perform job-related functions. If you are given a conditional offer of employment, you may be required to complete a post-job offer medical history questionnaire and/or undergo a medical examination. If required, all entering employees in the same job category will be subject to the same medical questionnaire and/or examination and all information will be kept confidential and in separate files.

V. Applicant Statement

Equal Opportunity Employer

This employer (hereafter the Company) is an equal opportunity employer and does not discriminate in recruitment, hiring, training, promotion, or other employment policies on the basis of age, race, sex, color, religion, national origin, disability, veteran status, genetic information, or any other basis that is prohibited by federal, state, or local law. No question in this application is intended to secure information to be used for such discrimination. In addition, the Company makes reasonable accommodation to the needs of disabled applicants and employees, so long as this does not create an undue hardship on the Company or threaten the health or safety of others at work. This application will be given every consideration, but its receipt does not imply that the applicant will be employed.


I certify that the answers given herein are true and complete to the best of my knowledge. I authorize the investigation of all matters contained in this application and hereby give the Company or their designated subsidiaries and affiliates permission to contact schools, previous employers, references, and others, and hereby release the Company and their designated subsidiaries and affiliates from any liability as a result of such contact. I understand that misrepresentations, omissions of facts or incomplete information requested in this application may remove me from further consideration for employment. In addition, if employed, any misrepresentations or omissions of facts called for in this application will be cause for dismissal at any time without any previous notice.