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All applicants for employment in the United States

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Application for Employment
The Company Is An Equal Opportunity Employer
All applicants for employment in the United States are required to complete and submit this Application for Employment.
The Company does not discriminate on the basis of sex, age, color, race, religion, marital status, national origin,
ancestry, sexual orientation, gender, gender identity, gender expression, physical & mental disability, medical condition,
genetic information, military and veteran status, or any other basis protected by federal, state or local law.
Applicant Information
LEGAL NAME
Last First Middle
HAVE YOU EVER WORKED UNDER ANOTHER NAME? YES NO
IF YES, UNDER WHAT NAME(S):
COMPLETE HOME ADDRESS include PO Box, Apt. #, etc.
Street City County State Zip Code
HOME PHONE BUSINESS OR OTHER PHONE
E-MAIL ADDRESS
Position Applying For
JOB TITLE/TYPE OF WORK DESIRED SALARY AVAILABLE START DATE
If necessary, are you available to work any of the following?
Overtime Holidays Work schedule other than M-F
YES YES YES
NO NO NO
HOW DID YOU LEARN ABOUT THIS OPENING?
DESIRED EMPLOYMENT: Full-Time Part-Time Temporary
HAVE YOU WORKED FOR OR APPLIED FOR A POSITION AT THE COMPANY BEFORE? YES NO
If yes, what position(s)?
DO YOU HAVE ANY RELATIVES WORKING HERE? YES NO If yes, who?
IF HIRED, CAN YOU SUBMIT VERIFICATION OF YOUR LEGAL RIGHT TO WORK IN THE U.S.? YES NO
ARE YOU OVER 18 YEARS OF AGE? YES NO IF UNDER 18, DO YOU HAVE A WORK PERMIT? YES NO
Education Begin with most recent college/university/technical school
NAME OF EDUCATIONAL INSTITUTION/LOCATION
MAJOR
NO. OF
YEARS
GRADUATE
DIPLOMA/DEGREE
YES NO
YES NO
YES NO
ANY PROFESSIONAL DESIGNATIONS, TRAINING, PATENTS, PUBLICATIONS, COMPUTER SKILLS RELATED TO THE JOB SOUGHT:
REV Sept. 2017
Security
Criminal background checking will be addressed at a later stage in the candidate process in keeping with and to the extent allowed
by applicable law.
For applicants in Florida ONLY:
(1) Have you ever been a defendant in a civil action for intentional tort? (An intentional tort is a civil wrong resulting from an
intentional act. Examples of an intentional tort include assault, battery, false imprisonment, and intentional infliction of emotional
distress.)
YES NO
(2) If yes, please describe the nature of the intentional tort and the disposition of the action (attach additional sheets if necessary).
Employment History List current/most recent position first (attach additional sheets if necessary).
1
COMPLETE ALL JOB HISTORY REGARDLESS OF RESUME ATTACHMENT
NAME OF EMPLOYER
ADDRESS/LOCATION
DATES EMPLOYED
From To
TYPE OF BUSINESS
POSITION/TITLE
MANAGER’S NAME
MANAGER’S TITLE
PHONE
REASON FOR LEAVING:
NAME OF EMPLOYER
ADDRESS/LOCATION
DATES EMPLOYED
From To
TYPE OF BUSINESS
POSITION/TITLE
MANAGER’S NAME
MANAGER’S TITLE
PHONE
REASON FOR LEAVING:
NAME OF EMPLOYER
ADDRESS/LOCATION
DATES EMPLOYED
From To
TYPE OF BUSINESS
POSITION/TITLE
MANAGER’S NAME
MANAGER’S TITLE
PHONE
REASON FOR LEAVING:
References: List three people (other than relatives) who are in a position to evaluate your previous employment performance, preferably
former supervisors or people with whom you have worked. (If applying for a supervisory position, please include one direct report.)
NAME
TITLE
COMPANY
PHONE
NAME
TITLE
COMPANY
PHONE
NAME
TITLE
COMPANY
PHONE
1
This application does not ask for prior salary history. This complies with regulations in various
cities, counties and states prohibiting employers from asking applicants for such information.
Please read the below carefully and then initial next to each paragraph.
Please sign and date in the space provided at the bottom of this page.
APPLICANT’S CERTIFICATION AND RELEASE
INITIALS
I authorize the Company to verify, in any manner, all statements made by me. The Company may, for example, interview
former employers, co-workers, schools, references, or others and request information and supporting documentation such as transcripts
and evaluations.
I authorize any and all former employers, references, or educational institutions to release all information relevant to
my employment or education to the Company, without giving me prior notice.
I release from any liability or responsibility all persons, companies and corporations supplying any information in verifying
my statements above, as well as the Company in connection with its obtaining such information for use in verifying my statements
above.
I shall preserve in strictest confidence all information regarding the business or customers of the Company that may
be disclosed to me or come to my attention in the process of applying for a position with the Company.
If employed by the Company, I agree to comply with the Company’s policies and procedures, safety rules, and
cooperate in any reasonable security investigation. I understand that I am not employed by or entitled to employment by the
Company unless and until I have received and accepted a written offer of employment from a Company representative. I also
understand that no other act of the Company, including the acceptance of my application for employment, the scheduling of
interviews with me, or any oral or written statements of interest or encouragement, creates an employment relationship with me, and
I will not rely on any such act of the Company. I understand that if I am employed by the Company, such employment is “at-will,”
which means that my employment and related compensation may be terminated at any time, with or without cause, and with or
without advance notice by me or by the Company.
I understand that any misrepresentation or omission of fact on this application, my resume, any supplementary materials
submitted by me, and interview responses, may be cause for a refusal to hire me or the termination of employment at any time during
the period of my employment.
I have reviewed this application personally, and I agree that all statements I have made on this application, in my
resume, and other supplementary materials submitted by me are true and correct. I have not knowingly withheld any information that
might adversely affect my chance for employment.
APPLICANT SIGNATURE: DATE
© 2017 TriNet. All rights reserved. All trademarks, trade names, service marks and logos referenced herein belong to their respective companies. Sept. 2017.
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All applicants for employment in the United States

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Completed 5 November 2021

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