NAME

SOC. SEC. NO.

ADDRESS

TELEPHONE (      )

Are you 18 years or older?  YES     NO    

If hired, can you provide the documents required to prove that you are authorized to work in the U.S.?  YES     NO    

Please list any additional information such as licenses, professional degrees, that you consider important for the job to which you have applied:

I understand that the employer follows an employment-at-will policy, in that I or the employer may terminate my employment any time, or for any reason consistent with applicable state or federal law. I understand that this application is not a contract of employment. I understand that to be employed I must be lawfully authorized to work in the United States, and I must show the employer documents that will prove this if I am offered the job.

I understand that the company will thoroughly investigate my work and personal history and verify all data given on the application, on related papers, and in interviews. I authorize all individuals, schools and firms named within to provide any information requested about me, and I release them from all liability for damage in providing this information.

I certify that all the statements herein are true and understand that any falsification or willful omission shall be sufficient cause for dismissal or refusal of employment.