Special Skills and Qualifications: Please summarize special job-related skills and qualifications
acquired from employment or other experience. You may exclude organizations which indicate race,
color, religion, gender, national origin, handicap or other protected status.
APPLICANT'S STATEMENT: 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 60 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 the 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 such change is specifically acknowledged in
writing by an authorized executive of this organization.
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, including submitting to a pre-employment drug screen.
Signature of applicant
Employees are treated during employment without regard to race, color, religion, sex, national origin,
age, marital or veteran status, medical condition or handicap, or any other legally protected status. As
an employer with an Affirmative Action Program, we comply with government regulations, including
Affirmative Action responsibilities where they apply.
APPLICATION PROCESS: To receive consideration, applicants must complete this application in full. If
a resume is submitted for part of the information requested on this application, applicants must be
certain that the resume contain all of the information on this application.
Complete Online, Print, Sign, Return to Above Address
How did you hear about this job: __ City Website __ Facebook __ Newspaper __ Other: _______________
RETURN APPLICATIONS TO: HUMAN RESOURCES, 212 CHESTNUT STREET, BEREA, KY 40403