| Application for Employment
We are an equal opportunity employer and consider applicants for all positions without regard to race, sex,
national origin, age, marital status, the presence of a non-job related medical condition or handicap, or any
legally protected status. Please complete as much of the application as possible.
Complete Name Position you are applying for:
City, State, Zip Are you seeking full or part time employment
Email When can you start work?
Are you legally eligible for employment in the United States?
Yes No Social Security Number:
Expected rate of pay (hourly)
Do you have a valid New York State Driver's License? Yes No D.L.#
License Expiration Date: List any tickets received in the past 5 years.
Drivers License Class (A,B,D):
Have you ever been convicted of a felony?
Yes No If yes, please explain:
Level Name and Location of School Number of years Subjects Studied
Employment History (Most Recent First)
Please include Company Name, Address, Phone Number, Position Held, Dates Employed, Rate of Pay,
Reason For Leaving, and Name of Supervisor:
Industry Experience and Certifications
Please list any qualifications, experience, and/or certifications within the industry:
Terms of Application
“I understand and agree that I may be required to go for a drug screening test as a condition of hiring or continued employment. I
agree to consent to same as may be designated by the Company and to release the Company, its directors, officers, agents, or
employees from any claims arising in connection with the use of such tests and I understand also that I am required to abide by all
rules and regulations.
I certify that the answers given herein are true and complete. I authorize investigation of all statements contained in this application
of employment as may be necessary in arriving at an employment decision.
This application for employment shall be active for a period of 45 days. 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 hereby 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 an
employee at any time with or without cause. It is further understood that this “at will” employment relationship may not be changed
by any written document or by conduct unless an authorized executive of this organization specifically acknowledges such change in
In the event of employment, I understand that false or misleading information given in my application or interview(s) may result in
I AGREE TO THE TERMS I DO NOT AGREE TO THE TERMS
Thank you for your interest in an employment opportunity with our firm. Do to the large volume of applications
received by our office, we are not able to confirm receipt of your application. You will be contacted via phone or
email to setup an interview, if your application is satisfactory based on our requirements.
Feel free to call or email our office with any questions.