Employment Application

Personal Information

Date: Social Security Number:

Name

Last: First: Middle:

Present Address:

Street: City: State: Zip:

Permanent Address:

Street: City: State: Zip:

Phone Number:

Referred By: Are you 18 years of age or Older? Yes No

Email Address:

Employement Desired

Position: Date you can Start? Salery desired?

Are you Employed now? Yes No
If so, may we Inquire your Present Employer? Yes No

Ever Applied to this Company Before? Yes No
Where? When?

Education

	Name and Location of School	Last Year Completed	Did you Graduate	Subjects Studied and Degree(s) Recieved
Grammar School			Yes No
High School			Yes No
College			Yes No
Trade, Business or Correspondance School			Yes No

General

Subjects of Special Study or Research Work

Job Related Skills (typing, driver's license, etc.)

Activities Other than Religious(Civic, Athletic, etc.)

Exclude Organizations, the name or character of which indicates the race, sex, color, or national origin of its members

Former Employers

Date, Month and Year - From: To
Name and Address of Employer:
Salary (upon Leaving): Position:
Reason for Leaving?:

References - List below three persons not related to you, whom you have known at least one year.

Name: Address:
Position: Years Acquainted:

“UNDER MARYLAND LAW AN EMPLOYER MAY NOT REQUIRE OR DEMAND ANY APPLICANT FOR EMPLOYMENT OR PROSPECTIVE EMPLOYMENT OR ANY EMPLOYEE TO SUBMIT TO OR TAKE A POLYGRAPH, LIE DETECTOR OR SIMILAR TEST OR EXAMINATION AS A CONDITION OF EMPLOYMENT OR CONTINUED EMPLOYMENT, ANY EMPLOYER WHO VIOLATES THIS PROVISION IS GUILTY OF A MISDEMEANOR AND SUBJECT TO A FINE NOT TO EXCEED $100.00.”

“It is unlawful in Massachusetts to require or administer a lie detector test as a condition of employment or continued employment. An employer who violates this law shall be subject to criminal penalties and civil liability.”

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.

AUTHORIZATION
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 discloser. 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.

If I am offered employment I agree to submit to a medical examination and drug test before starting work. If employed, I also agree to submit examination or drug test 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

I agree