APPLICATION FOR EMPLOYMENT
Please Answer All Questions. Resumes are not a substitute for a completed application.
We are an equal opportunity employer. Applicants are considered for positions without regard to race, religion, sex, national origin, age, disability, or any other consideration made unlawful by applicable federal, state, or local laws.
Where did you hear about our job posting? * Facebook, Twitter, and/or LinkedIn
Indeed.com
the Washington Post
Craigslist.com
Current employee
Other, please specify:
Position Applied for *:
Name: *
Email: *
Telephone Number: * ( )
Present Address (Street, Apt. or Unit No.): *
City/State/Zip: *
Desired Salary:
Are you able at the time of employment to submit verification of your legal right to work in the U.S.? (Verification and completion of Form I-9 must be submitted no later than three business days after date of hire.) * Yes
No
If under the age of 18, can you produce the necessary work certificate at the time of employment? * Yes
No
Type of employment desired? * Full-time
Part-time
If part time, specify hours:
Are you willing to work overtime? * Yes
No
Date on which you can start: *
Have you ever applied to this Company before? * Yes
No
If yes, when did you apply?

Where did you apply?
Have you ever initiated an act of violence in the workplace? * Yes
No
If Yes, please explain so that individual circumstances can be considered. (A Yes answer will not necessarily disqualify you from employment.)


(Use 2 rows if necessary)
List special technical skills that you feel qualify you for the job for which you are applying (i.e., computer programming/language, software, equipment operation, special tools or machines etc.)
Education School Name and Location Course of Study Graduate? # Yrs Degree
High School
College
Bus/Tech/Trade
Or Post College

Honors Received:
WORK EXPERIENCE
Start with your present or last place of employment. You may include any verifiable work performed on a volunteer basis, internships, or military service.
1.
Employer Name:


Address:


Type of Business:


Phone:
( )

Dates Employed from:
/ / to / /

Job Title:


Supervisor's Name:


May we contact?
Yes
No

Wages Start:


Wages Final:


Reason for Leaving:


Duties:



2.
Employer Name:


Address:


Type of Business:


Phone:
( )

Dates Employed from:
/ / to / /

Job Title:


Supervisor's Name:


May we contact?
Yes
No

Wages Start:


Wages Final:


Reason for Leaving:


Duties:



3.
Employer Name:


Address:


Type of Business:


Phone:
( )

Dates Employed from:
/ / to / /

Job Title:


Supervisor's Name:


May we contact?
Yes
No

Wages Start:


Wages Final:


Reason for Leaving:


Duties:
REFERENCES
Please list the names of additional work-related references that we may call. Individuals with no prior work experience may list school or volunteer related references.
NAME POSITION COMPANY WORK RELATIONSHIP TELEPHONE#
APPLICANT CERTIFICATION
I understand and agree that if driving is a requirement of the job for which I am applying, my employment and/or continued employment is contingent on possessing a valid driver’s license and automobile liability insurance in an amount equal to the minimum required by the state where I reside.

I understand that the Company may now have, or may establish, a drug-free workplace or drug and/or alcohol testing program consistent with applicable federal, state, and local law. If the Company has such a program and I am offered a conditional offer of employment, I understand that if a pre-employment (post-offer) drug and/or alcohol test is positive, the employment offer may be withdrawn. I agree to work under the conditions requiring a drug-free workplace, consistent with applicable federal, state, and local law. I also understand that all employees of the location, pursuant to the Company’s policy and federal, state, and local law, may be subject to urinalysis and/or blood screening or other medically recognized tests designed to detect the presence of alcohol or controlled drugs. If employed, I understand that the taking of alcohol and/or drug tests is a condition of continual employment and I agree to undergo alcohol and drug testing consistent with the Company’s policies and applicable federal, state, and local law.

If employed by the Company, I understand and agree that the Company, to the extent permitted by federal, state, and local law, may exercise its right, without prior warning or notice, to conduct investigations of property (including, but not limited to, files, lockers, desks, vehicles, and computers) and, in certain circumstances, my personal property.

I understand and agree that as a condition of employment and to the extent permitted by federal, state, and local law, I may be required to sign a confidentiality, non-compete, and/or conflict of interest statement. I certify that all the information on this application, my resume, or any supporting documents is complete and accurate to the best of my knowledge. I understand that any falsification, misrepresentation, or omission of any information may result in disqualification from consideration for employment or, if employed, disciplinary action, up to and including immediate dismissal.

I UNDERSTAND THAT NEITHER THIS APPLICATION NOR ANY COMMUNICATION BY A MANAGEMENT REPRESENTATIVE IS INTENDED TO CREATE OR DOES CREATE A CONTRACT OF EMPLOYMENT, OFFER, OR PROMISE OF EMPLOYMENT. I ACKNOWLEDGE THAT IF HIRED BY THE COMPANY, EMPLOYMENT IS ON AN AT-WILL BASIS. THIS MEANS THE COMPANY IS FREE TO TERMINATE MY EMPLOYMENT AT ANY TIME, WITH OR WITHOUT CAUSE OR ADVANCE NOTICE, IN ACCORDANCE WITH STATE LAW, AND ACCEPTANCE OF EMPLOYMENT IS NOT A CONTRACT OF EMPLOYMENT FOR ANY SPECIFIED TIME. SIMILARLY, I AM FREE TO TERMINATE MY EMPLOYMENT WITH THE COMPANY AT ANY TIME FOR ANY REASON. THIS AT-WILL PROVISION MAY BE MODIFIED OR WAIVED ONLY IN A WRITTEN AGREEMENT SIGNED BY AN AUTHORIZED REPRESENTATIVE OF THE COMPANY AND ME. I AGREE TO CONFORM TO THE RULES AND REGULATIONS OF THE COMPANY, AND I UNDERSTAND THAT THE COMPANY HAS COMPLETE DISCRETION TO MODIFY SUCH RULES AND REGULATIONS AT ANY TIME, EXCEPT THAT IT WILL NOT MODIFY ITS POLICY OF EMPLOYMENT AT-WILL.


I authorize the Company or its agents to confirm all statements contained in this application and/or resume as it related to the position I am seeking and to the extent permitted by federal, state, or local law. I agree to complete any requisite authorization forms for the background investigation. I authorize and consent to, without reservation, any party or agency contacted by this employer to furnish the above-mentioned information. I hereby release, discharge and hold harmless, to the extent permitted by federal, state, and local law, any party delivering information to the Company or its duly authorized representative pursuant to this authorization from any liability, claims, charges, or causes of action which I may have as a result of the delivery or disclosure of the above requested information. I hereby release from liability the Company and its representative for seeking such information and all other persons, corporations, or organizations furnishing such information.

I understand this Company hires only individuals who are legally eligible to work in the United States.

Applicant Full Name:


Date:


UNDER MARYLAND LAW, AN EMPLOYER MAY NOT REQUIRE OR DEMAND, AS CONDITION OF EMPLOYMENT, PROSPECTIVE EMPLOYMENT, OR CONTINUED EMPLOYMENT, THAT AN INDIVIDUAL SUBMIT TO OR TAKE A LIE DETECTOR OR SIMILAR TEST. AN EMPLOYER WHO VIOLATES THIS LAW IS GUILTY OF A MISDEMEANOR AND SUBJECT TO A FINE NOT EXCEEDING $100. UNDER MASSACHUSETTS LAW, IT IS UNLAWFUL FOR AN EMPLOYER TO REQUIRE OR TO ADMINISTER A LIE DETECTOR TEST AS A CONDITION OF EMPLOYMENT OR CONTINUED EMPLOYMENT. FEDERAL AND/OR STATE LAW MAY PROHIBIT THE USE OF POLYGRAPH OR SIMILAR TESTS AS WELL