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SDAP Employment Application

I understand that the company is committed to providing equal opportunity to all employment practices including but not limited to select on, hiring, promo on, transfer, and compensation to all qualified applicants and employees without regard to age, race, color, national origin, sex, religion, handicap or disability, citizenship status, service member status, or any other category protected by federal, state, or local law.

I authorize former and present employers, and professional, work, and personal references listed in the application and any other individuals I may name, to give the Company or its designee any and all information concerning my previous employment and any pertinent informa on they may have, personal or otherwise, and release such par es from all liability for any damages that may result from furnishing same to the Company. I also authorize the Company to provide truthful information concerning my employment with it to future employers, and I agree to hold it harmless for providing such information.

I understand that the Company reserves the right, to the extent permitted by law, to require drug and alcohol screening tests of an applicant or an employee either prior to employment or any me during employment and I hereby give my consent to any such tests. I consent to the release of the results of any such tests to the Company or its designee. I release the Company and its designee from any and all liability and damages that may result or arise from any drug test or the provision of information in connection with such a test.

I understand that this employment application and any other Company documents are not promises of my employment. Should I be employed, I understand that my employment will be on a trial period for 90 days from the date of my hiring and that I will remain an at will employee thereafter. I further understand that, if I am employed, I can terminate my employment at any me with or without cause and with or without advance notice and that the Company has a similar right. I understand that no manager, representative, or agent of the Company has any authority to enter into any agreement for employment for any specified period of me or to make any agreement contrary to the foregoing, except that the General Manager may do so in writing.

In return for the Company’s agreement to arbitrate legal disputes and for considering this application, I agree by signing below that any dispute of a legal nature arising under federal, state, or local law between me and the Company (including any such claim regarding discrimination, harassment, or any other legal dispute relating to my employment arising under any labor, employment, or civil rights law) will be subject to final and binding arbitration in accordance with the Company’s arbitration procedures. I understand that the arbitrator, who will serve as judge and jury, has the same authority to award money damages and other relief, as does a court or jury. If employed, and if required, I agree to sign a stand-alone arbitration agreement that would supplement this one. The Company’s arbitration procedures are available for my review on request.

I certify that the information given by me on this application and during the interview process is true and complete in all respects, and I agree that if the information is found to be false, misleading, or unsatisfactory in any respect (in the Company’s judgment) that I will be disqualified from consideration for employment or subject to immediate dismissal if discovered aer I am hired.

I certify that I have received a separate written no fica on that the Company may obtain a “consumer report” (for example, criminal history, driving records, etc.) on me for use in connection with my application and, if I am hired, my employment. I authorize the Company to obtain this report.

This application will be considered “active” for a maximum of thirty (30) days. If you wish to be considered for employment aer that me, you must reapply.

Applicant’s Signature * (Draw with Mouse)

Date *

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PERSONAL INFORMATION

Each inquiry on this applicaon must be fully answered or completed. Otherwise, you will not be considered for employment

Last Name *

First Name *

Middle Name

E-Mail Address *

Present Address (Include City, State, Zip) *

How long have you lived there *

Previous Address (Include City, State, Zip) *

How long have you lived there *

EMPLOYMENT INFORMATION

Desired Position *

Available Start Date *

Placement Desired

Full-TimePart-TimeTemporary

Desired Hourly Rate/Salary

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CURRENT AND PREVIOUS EMPLOYMENT

Please list the names of your present or previous employers in chronological order with present or last employer listed first. Include part-me, seasonal and all other employment. If self-employed give company name and supply business references. If you need more space please request addional employment history pages from front office. DO NOT ANSWER “SEE RESUME” Fill our this form completely.

Have you ever been terminated or asked to resign from any job?

YesNo

If yes, please explain circumstances

Do you have any friends or relatives working here or for a related enty?

YesNo

If yes, please give Name(s), relationship and location

Have you ever plead no contest, nolo, or guilty to a crime, or been convicted of a crime?

YesNo

Are any charges currently pending against you?

YesNo

Has any adjudication ever been withheld?

YesNo

NOTE: Answering “yes” to these questions does not constitute an automatic bar to employment. If you answered yes to any of the preceding questions, please give dates and details:

How were you referred to us?

Describe *

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EDUCATION HISTORY

Education Years Completed School Name & Location Course of Study or Major Specialized Experience, Training Skills, and Extra-Cirricular Activties
High School
College/University
Graduate/Professional
Trade/Correspondence

List any job related designations, certifications, licenses, or courses that may be applicable to the position for which you are applying:

OTHER INFORMATION:

Please describe any other experience that you have which would be relevant to the job for which you are applying:

DRIVING HISTORY

Driving is an essential function of the job you are applying for, please answer these questions below.

Do you have a current valid drivers license?

YesNo

Has your license ever been suspended or revoked?

YesNo

If yes, please explain

Do you have personal automobile insurance?

YesNo

If yes, please explain

Have you ever been denied personal automobile insurance or has it ever been terminated or suspended?

YesNo

If yes, please explain

Have you ever been convicted, pled guilty, or pled nolo to a charge of DWI or DUI?

YesNo

Are any such charges currently pending against you? If yes, to either question please explain

Offense Type Date Location Comments

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