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We are an equal opportunity employer, dedicated to a policy of non-discrimination in employment on any basis including race, color, age, sex, religion, handicap or national origin.

First Name:
Last Name:
Street Address:
City:
State:
Home or Cell Phone:
E-Mail Address:
Referred by (enter N/A if no referral):
Are you 18 years of age or older?:
Position Desired:
Date You Can Start:
Salary Desired:
Are you Employed Now?:
If So, May We Inquire of Your Present Employer?:
Ever Apply to this Company Before?:
Name of High School & Location:
Last Year of High School Completed:
Did You Graduate from High School?:
Name of College & Location (if no college, answer none):
Last Year of College Completed:
Did You Graduate from College?:
Subjects Studied/Degree Received (if no college, answer N/A):
Trade, Business or Correspondence School & Location (if none, enter N/A):
Last Year of Trade, Business or Correspondence School Completed:
Did You Graduate from Trade, Business or Correspondence School?:
Subjects Studied/Degree Received (if none, enter N/A):
Please Elaborate on Why this Position Interests You :
Job Related Skills:
Activities Other Than Religious (Civic, Athletic, etc.)? Exclude organizations, the name or character of which indicates the race, sex, color or National origin of its members:
1. FORMER EMPLOYER (most current first):
1. From - To (Month/Year):
1. Salary (upon leaving):
1. Position:
1. Reason for Leaving:
2. FORMER EMPLOYER (N/A if no other employer):
2. From - To (Month/Year) (N/A if no other employer):
2. Salary (upon leaving) (N/A if no other employer):
2. Position (N/A if no other employer):
2. Reason for Leaving (N/A if no other employer):
3. FORMER EMPLOYER (N/A if no other employer):
3. From - To (Month/Year) (N/A if no other employer):
3. Salary (upon leaving) (N/A if no other employer):
3. Position (N/A if no other employer):
3. Reason for Leaving (N/A if no other employer):
Reference #1 (List first/last name of person not related to you, whom you have known at least 1 year):
Reference #1 - Works for What Company?:
Reference #1 - Job Position:
Reference #1 - Email Address:
Refrence #1 - Phone Number:
Reference #2 (list first/last name of person note related to you, whom you have known at least 1 year):
Reference #2 - Works for What Company?:
Reference #2 - Job Position:
Reference #2 - Email Address:
Reference #2 - Phone Number:
 

“UNDER MARYLAND LAW AN EMPLOYER MAY NOT REQUIRE OR DEMAND ANY APPLICANT FOR EMPLOYMENT OR PROSPECTIVE EMPLOYMENT OR ANY EMPLOYEE TO SUBMIT TO OR TAKE A POLYGRAPH, LIE DETECTOR OR SIMILAR TEST OR EXAMINATION AS A CONDITION OF EMPLOYMENT OR CONTINUED EMPLOYMENT, ANY EMPLOYER WHO VIOLATES THIS PROVISION IS GUILTY OF A MISDEMEANOR AND SUBJECT TO A FINE NOT TO EXCEED $100.”

“ It is unlawful in Massachusetts to require or administer a lie detector test as a condition of employment or continued employment. An employer who violates this law shall be subject to criminal penalties and civil liability.”

If you are to be hired by the company, you will be required to attest to your identity and employment eligibility, and to present documents confirming your identity and employment eligibility. You cannot be hired if you cannot comply with these requirements.

 

AUTHORIZATION
I certify that the facts contained in this application (and accompanying resume, if any) are true and complete to the best of my knowledge. I understand that any false statement omission, or misrepresentation on this application is sufficient cause for refusal to hire, or dismissal if I have been employed, no matter when discovered by the Company.

I understand that any employment is conditioned on a background check. I authorize the Company to thoroughly investigate all statements contained in my application or resume, and I authorize my former employers and references to disclose information regarding my former employment, character and general reputation to the Company, without giving me prior notice of such disclosure, In addition, I release the Company, any former employers and all references listed above from any and all claims, demands or liabilities arising out of or related to such investigation or disclosure.

If I am offered employment I agree to submit to a medical examination and drug test before starting work. If employed, I also agree to submit to a medical examination or drug test at any time deemed appropriate by the Company and as permitted by law. I consent to such examinations and tests, and I request that the examining doctor disclose to the Company the results of the examination, which results shall remain confidential and segregated from my personnel file. i understand that my employment or continued employment, to the extent permitted by law, is contingent upon satisfactory medical examinations and drug test, and if I am hired a condition of my employment will be that I abide by the Company’s Drug and Alcohol Policy.

I understand that filing out this form does not indicate there is a position open and does not obligate the Company to hire. If hired I agree to abide by all Company work rules policies and procedures. The Company retains the right to revise its policies or procedures in whole or in part, at any time.

 

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