Service Application

Service Application

Service Application



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Personal Data


U.S. Military History

Employment History

Employer 1

Employer 2

I certify that I have read and understood all of this employment application. It is agreed and understood that the employer or his agents may investigate my background to ascertain any and all information of concern to my employment history, whether same is of record or not, and I release employers and other person named herein from all liability for any damages on account of furnishing such information. I understand that, as applicant for a position with this company, I may asked to demonstrate that I am capable or performing tasks which are pertinent to the job. I also understand that if offered a job, it may be conditioned on the results of a drug test by an approved physician and a driving record check from the Department of Motor Vehicles.

I further certify that I am a genuine applicant for employment and this application is being submitted solely for the purpose of seeking employment with the employer and for no other reason. I understand that this application is not intended to a contract of employment.
I agree to furnish such additional information and complete such examinations as may be required to complete my employment file.
I also understand that misrepresentation or omission of information or facts may result in my rejection or dismissal.
As a condition of employment I understand that I must provide proof of eligibility to work in the United States, pursuant of Federal Immigration Laws.

If hired, I agree to abide by all rules and policies of the employer.

This certifies that this application was completed by me, and that all entries on it and information in it are true and complete to the best of my knowledge.

Confirmation of Honest and Accurate Completion

By my signature and initials placed below, I promise that I have personally completed this application. I declare under penalty of perjury that the information provided in this employment application (and accompanying resume, if applicable) is true and complete, and I understand that any false information or significant omissions may disqualify me from further consideration for employment and may be justification for my dismissal from employment if discovered at a later date. I understand that any job offer is conditional, based on the satisfactory review of my qualifications including any and all background or drug screening which may be required.

Drug Screening

I understand that it is the policy of the company to conduct drug tests of job applicants for the purpose of detecting drug abuse, and that one of the requirements for consideration of employment with the company is the satisfactory passing of the company's drug test. For the purpose of being further considered for employment, I hereby agree to submit to a drug test. I understand that favorable test results will not necessarily guarantee that I will be employed by the company. If I am accepted for employment, I agree to take drug tests when ever requested by the company, and I understand that the taking of such tests is a condition of my continued employment. I also give consent to the testing agency to release to the company and other officially interested parties of my tests and other test-related information. At this time I consent to a drug test.

Other Employment and/or Activities

I understand that, if hired, I may not hold other employment or engage in other activities that create a conflict of interest with my position with the company, unless I have been given permission in writing by the company.

Authorization to Obtain Information

I voluntarily and knowingly authorize any present and past employer or supervisor, educational institution, administrator, law enforcement agency, state, local, or federal agency, credit bureau, collection company, private business, military branch or the national personnel records center, personal reference, and/or any other persons to give records or information they may have concerning my criminal history, motor vehicle history, educational history, license history, employment history (including character, earnings, and reasons for termination), or any other information requested by the company deemed to my employment.


I voluntarily waive all recourse, and release any company, individual, or organization from liability for complying with any request from the company or agents for the company (including any consumer reporting agency) to obtain any information from any source whatsoever relating to my application of employment. I further release the company or any individual within the company regarding the use of any information received which may have bearing on my application for employment

Notification of Compliance

I agree to immediately notify the company if I should be convicted of a crime while my application is pending or during my employment, if hired. If I become employee, in consideration of my employment, I agree to comply with the rules, regulations, policies, and procedures of the company.

Agreement for At-Will Employment

I understand and agree that nothing contained in this application, or conveyed during any interview which may be granted, or during my employment if hired, is intended to create any employment contract between me and the company. In addition, I understand and agree that if you employ me, in considerations of my employment, my employment will be at-will, for no definite or determinable period of time, and may, regardless of the date of payment of my wages or salary, or terminated at any time, for any reason or for no reason at all, with or without prior notice, at the option of the company or me. I understand and agree that no promises or representations contrary to the foregoing are binding on the company unless made in writing and signed by me and authorized officer of the company. I promise that I have relied, and will not rely, on any oral or written statements to the contrary. I understand and agree this is the entire agreement between me and the company regarding the term of my employment and replaces any other oral or written agreement or understanding.