Personal Data
(This information will be used only for child labor law purposes).
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Note: It is not necessary for you to identify unavailability for work because of religious observance or practice or any other protected classification. Subsequent to any job offer, we will consider whether a reasonable accommodation can be made.
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Note: The Federal Immigration and Reform and Control Act of 1986 requires that a DHS Employment Eligibility Verification “Form I-9” be completed for every new hire and that within 3 business days of beginning work every new hire must present to the employer documentation establishing his/her identity and authorization to work. This federal requirement must be satisfied as a condition of employment.
EDUCATION
Describe any educational degrees, skills, training or experience you believe are relevant to the job applied for:
High School
College or University
Technical/GED
Licenses/Certification/Other
EMPLOYMENT HISTORY
Please complete for all full-time or part-time employment beginning with most recent employer. You may
include as part of your employment history any verified work performed on a volunteer basis. All applicants should start with their most recent job, include military assignments and voluntary employment and provide ten (10) years of history. (A separate sheet may be attached.) You must explain any gaps in your employment history.
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MILITARY
(Complete only if you served in the military.)
Describe any military skills, training or experience you believe are relevant to the job you applied for:
APPLICANT’S ACKNOWLEDGMENT
I certify that the answers given herein and during the entire application process (including but not limited
to information provided in resumes, attachments to this application, interviews or otherwise (if applicable))
are true and complete to the best of my knowledge.
I understand that any misrepresentations, omissions of facts or incomplete answers during the application
process may disqualify me from further consideration for employment. I further understand that, if
employed, any misrepresentations or omissions of facts during the application process may be cause for
my dismissal at any time without prior notice.
I consent to and authorize the Company and ADP TotalSource® to contact my
former employers, references, and any and all other persons and organizations
for information bearing upon my qualifications for employment.
I further authorize the listed employers, schools and personal references to give
the Company or ADP TotalSource (without further notice to me) any and all
information about my previous employment and education, along with any other
pertinent information they may have and hereby waive any actions which I may
have against either party(ies) for providing a good faith reference.
I EXPRESSLY AGREE AND UNDERSTAND THAT, IF EMPLOYED, MY EMPLOYMENT IS NOT FOR A
SPECIFIC TERM, IS BASED ON MUTUAL CONSENT AND MAY BE TERMINATED BY ME OR THE
COMPANY OR ADP TOTALSOURCE WITH OR WITHOUT NOTICE OR CAUSE AT ANY TIME. I
FURTHER UNDERSTAND THAT NO ORAL PROMISE, EMPLOYER POLICY, CUSTOM, BUSINESS
PRACTICE OR OTHER PROCEDURE (INCLUDING THE BASIC EMPLOYMENT POLICIES, PERSONNEL HANDBOOK OR ANY PERSONNEL MANUALS) CONSTITUTES AN EMPLOYMENT CONTRACT OR MODIFICATION OF THE AT-WILL EMPLOYMENT RELATIONSHIP BETWEEN ME AND THE COMPANY OR ADP TOTALSOURCE.
I ALSO UNDERSTAND THAT MY AT-WILL EMPLOYMENT STATUS WITH THE COMPANY MAY ONLY
BE ALTERED IN AN INDIVIDUAL CASE OR GENERALLY IN A WRITING SIGNED BY THE OWNER,
PRESIDENT OR CEO OF THE COMPANY AND THAT MY AT-WILL STATUS WITH ADP
TOTALSOURCE MAY ONLY BE ALTERED IN AN INDIVIDUAL CASE OR GENERALLY IN A WRITING
SIGNED BY THE PRESIDENT OF ADP TOTALSOURCE.
I understand that I may be required to qualify for employment based on additional employment criteria.
For example, I may be required to take job-related tests; take a driver’s examination or take a preemployment drug test. If I am offered employment or start work before any required test is completed, I understand that my employment is contingent on a satisfactory result on all required tests. I authorize the Company and ADP TotalSource to release the results of my pre-employment drug/alcohol test (if any),any information on this application and any relevant information about me to each other and to other ADP TotalSource clients for whom I have applied for employment, and release the Company, ADP
TotalSource and its clients from any and all claims related to the lawful release of this information. I
further authorize the release of any background check results and of any drug/alcohol test to any state or
federal authority requesting such information and in response to a valid subpoena or other legal
document.
Sign below, and then click submit