Application Form

1. Please read “APPLICANT NOTE”.
2. COMPLETE THIS FORM IN ITS ENTIRETY, EVEN IF ATTACHING A RESUME.
3. Print clearly; incomplete or illegible applications will not be processed.
4. Some packets may have an attached AFFIRMATIVE ACTION QUESTIONNAIRE. This information is being gathered for affirmative action under Section 503 of the Rehabilitation Act of 1793. The information requested is voluntary and will not be subject to any adverse treatment for refusing to complete the questionnaire.

I certify that answers given herein are true and complete to the best of my knowledge.

I authorize investigation of all statements contained in this application for employment as may be necessary in arriving at an employment decision. This application for employment shall be considered active for a period of time not to exceed three months. Any applicant wishing to be considered for employment beyond this time period should inquire as to whether or not applications are being accepted at that time. I here by understand and acknowledge that, unless otherwise defined by applicable law, any employment relationship with this organization is of an “at will “ nature, which means that the Employee may resign at any time and the Employer may discharge Employee at any time with or without cause. It is further understood that this “at will” employment relationship may not be changed by any representative of the Employer. In the event of employment, I understand that false or misleading information given in my application or interview(s) may result in discharge. I understand, also, that I am required to abide by all rules and regulations of the employer.

In connection with my application for employment with you, I understand that an investigative report may be requested that will include information as to my character, work habits, performance and experience, along with reason for termination of past employment from previous employers. Further, I understand that you will be requesting information concerning my motor vehicle operation history, and criminal history from various state, private and insurance sources along with other public records available. A credit report may be required for certain positions.

I hereby authorize, without reservation, any law enforcement administrator, state agency, institution, information service bureau, employer or Insurance Company contacted by any outside service to furnish the above-mentioned information.

I further acknowledge that a telephone facsimile (FAX) or photographic copy shall be as valid as the original. This release includes all state and federal agencies.