APPLICATION FOR EMPLOYMENT

Your Job Interests

Education and Training

TECHNICAL SKILLS

Mark the following ONLY if applying for Manufacturing position job.

WORK EXPERIENCE

IF YOU HAVE PROVIDED A DETAILED RESUME, YOU DON NOT NEED TO FILL OUT THIS PART

MILITARY EXPERIENCE

Completing this section of the application is optional. Leave this area blank if you do not wish to answer.

PLEASE READ THE FOLLOWING PARAGRAPHS CAREFULLY BEFORE SIGNING By signing below, I certify that I have read, understand and agree to each of the following statements: All of the information I have supplied on this application is true, accurate and complete, to the best of my knowledge, and I have not knowingly withheld any information that, if know to the Company, would affect my application unfavorably. If I am hired by the Company, and if the Company discovers at any time during my employment that any of the statements or answers on this application are false, misleading or incomplete, I may be dismissed immediately from my job. This employment application will be considered active for ninety (90) days from the date below. If I want to be considered for a job with the Company after this period of time, I must fill out another application. If hired, I understand that this application becomes part of my official employment record. In consideration of my employment with the Company, I agree to abide by all the Company’s rules and regulations. If I am extended and offer of employment, I agree to submit to a medical examination ( if requested by the company) that may include testing for drugs or alcohol prior to beginning work with the Company . I understand that if I am employed by the Company, I may be required, when job related and consistent with the Company’s business needs, to undergo a medical examination. I further understand that I may be required to submit to a test for the use alcohol and / or of illegal drugs at any time. I understand that nothing in this employment application creates a contract of employment between the Company and me. If I am hired by the Company, my employment and compensations are “at will” which means that my employment can be terminated, either by the Company or me, with or without cause, and with or without notice. I understand that no manager or supervisor has the authority to make any employment agreement with me, either orally or in writing, that is not an at-will agreement. Only the President of the Company has the authority to enter into an employment agreement with me for any specified period of time. I agree to release to the Company or its designated agents, all medical information, including but no limited to files, reports, X-rays, evaluations and opinions held by medical personnel, to the extent such information is job-related and consistent with the Company’s business needs and agree to execute the necessary HIPAA-compliant release. I acknowledge that this is a general release and that if hired, it remains in effect for the duration of my employment. I give the Company my permission to conduct any investigation regarding the information contained in my employment application that the Company thinks is necessary to determine my qualifications for assuming a job with the Company. I give the Company permission to contact any former employer, school, college or university, utility company, credit or finance bureau or office, any personal or professional reference, or any other appropriate source or individual for the purpose of gathering any information, personal or otherwise, that such sources may have about my character, general reputation, credit, education or employment record, and I give my consent to any such source to release to the Company whatever information they have about me. I also unconditionally release all named and unnamed sources from any and all liability which might result from furnishing any information about me.