APPLICATION FOR EMPLOYMENT

Are you currently employed? YesNo

If employed, may we contact your current employer(s)? YesNo

Are you eligible to work in the United States? YesNo

Please indicate days and hours available to work: Morning, Evening, Nights

Monday

Tuesday

Wednesday

Thursday

Friday

Saturday

No Preference

Have you ever been convicted of a crime? YesNo

If yes, explain number of conviction(s), nature of offense(s) leading to conviction(s), how recently such offense(s) was/were committed, sentence(s) imposed, and type of rehabilitation:

Additional information/skills/knowledge/license(s) applicable to position you are applying for:

The information contained on this application is complete and accurate. I hereby authorize verification of any and all information contained in this application and on my resume, if provided. I certify that such statements are true and understand that misrepresentation or omission of facts called for in this form, or on any resume provided by me, is cause for termination of employment without notice.

THIS ORGANIZATION IS AN EQUAL OPPORTUNITY EMPLOYER. NO PERSON SHALL BE DENIED EMPLOYMENT ON THE BASIS OF RACE, AGE, ETHNICITY, NATIONAL ORIGIN, GENDER, SEXUAL ORIENTATION, RELIGION, CREED, VETERAN STATUS, MARITAL STATUS, DISABILITY OR ANY OTHER LEGALLY PROTECTED STATUS. Employment is contingent upon furnishing evidence of identity, employment eligibility, and qualifications