Application for Employment

"*" indicates required fields

MM slash DD slash YYYY
Address*
If you are under 18 and it is required, can you furnish a work permit?
Have you ever been employed here before?
Are you legally eligible for employment in this country?
MM slash DD slash YYYY
Are you able to meet attendance requirements for this position?
Are you able to perform the essential functions of the position applied for, with or without reasonable accommodation(s)?
Type of employment desired
Do you have a valid driver’s license?

Employment History

Please provide the following information for your past three (3) employers, beginning with the most recent:

Skills and Qualifications

Please summarize any special training, skills, licenses, and/or certificates that may qualify you as being able to perform the job-related functions of the position for which you are applying:

Educational Background

Professional References

How Did You Hear About Us?

BY SIGNING BELOW, I CERTIFY ALL OF THE INFORMATION I HAVE PROVIDED IN THIS APPLICATION IS TRUE AND ACCURATE. I UNDERSTAND THAT ANY MISREPRESENTATION OR MATERIAL OMISSION I MAKE ON THIS APPLICATION WILL BE SUFFICIENT CAUSE FOR THE COMPANY TO REJECT THIS APPLICATION, OR, IF I AM ALREADY EMPLOYED BY THE COMPANY, FOR THE COMPANY TO IMMEDIATELY TERMINATE MY EMPLOYMENT UPON DISCOVERY OF ANY SUCH MISREPRESENTATION OR MATERIAL OMISSION.

I HEREBY AUTHORIZE THE COMPANY TO THOROUGHLY INVESTIGATE MY BACKGROUND, REFERENCES, WORK RECORD, EDUCATION, AND ANY OTHER MATTERS RELATED TO MY SUITABILITY FOR EMPLOYMENT. IN ADDITION, I HEREBY AUTHORIZE ALL REFERENCES I HAVE LISTED ON THIS APPLICATION TO DISCLOSE TO THE COMPANY ANY AND ALL LETTERS, REPORTS, AND OTHER INFORMATION RELATED TO MY WORK RECORD, WITHOUT GIVING ME PRIOR NOTICE OF SUCH DISCLOSURE. MOREOVER, I HEREBY RELEASE THE COMPANY, MY FORMER EMPLOYERS, AND ALL OTHER PERSONS, CORPORATIONS, PARTNERSHIPS, AND ASSOCIATIONS FROM ANY AND ALL CLAIMS, DEMANDS, OR LIABILITIES ARISING OUT OF, OR IN ANY WAY RELATED TO, SUCH INVESTIGATION OR DISCLOSURE.

I UNDERSTAND THE COMPANY DOES NOT UNLAWFULLY DISCRIMINATE IN EMPLOYMENT AND THAT NO QUESTION OF THIS APPLICATION IS USED FOR THE PURPOSE OF LIMITING OR EXCUSING ANY APPLICANT FROM CONSIDERATION FOR EMPLOYMENT ON ANY BASIS PROHIBITED BY LOCAL, STATE, OR FEDERAL LAW. I FURTHER UNDERSTAND IT IS THE COMPANY’S POLICY NOT TO REFUSE TO HIRE A QUALIFIED INDIVIDUAL BECAUSE OF THAT PERSON’S NEED FOR A REASONABLE ACCOMMODATION AS REQUIRED BY APPLICABLE LAW.

I UNDERSTAND AND ACKNOWLEDGE THAT, IF HIRED, MY EMPLOYMENT IS “AT WILL,” MEANING THAT MY EMPLOYMENT WITH THE COMPANY IS VOLUNTARILY ENTERED INTO, AND THAT I AM FREE TO RESIGN AT WILL, AT ANY TIME, WITH OR WITHOUT NOTICE, AND WITH OR WITHOUT CAUSE. SIMILARLY, THE COMPANY MAY TERMINATE THE EMPLOYMENT RELATIONSHIP AT WILL, AT ANY TIME, WITH OR WITHOUT NOTICE, AND WITH OR WITHOUT CAUSE. I FURTHER UNDERSTAND AND ACKNOWLEDGE THAT I MAY BE DEMOTED OR DISCIPLINED, AND THAT THE TERMS OF MY EMPLOYMENT MAY BE ALTERED, AT ANY TIME, WITH OR WITHOUT CAUSE, AT THE SOLE DISCRETION OF THE COMPANY.

I UNDERSTAND AND ACKNOWLEDGE THAT NO INDIVIDUAL OTHER THAN THE OWNER OF THE COMPANY HAS THE AUTHORITY TO ENTER INTO ANY EMPLOYMENT OR OTHER AGREEMENT THAT MODIFIES THE “AT-WILL” EMPLOYMENT STATUS OF ANY EMPLOYEE. ANY SUCH MODIFICATION MUST BE IN A SINGLE WRITING SIGNED BY BOTH THE EMPLOYEE AND THE OWNER OF THE COMPANY. I FURTHER UNDERSTAND AND ACKNOWLEDGE THAT IN THE ABSENCE OF A SINGLE WRITING SIGNED BY ME AND THE OWNER OF THE COMPANY THAT EXPRESSLY PROVIDES FOR EMPLOYMENT FOR A SPECIFIED TERM, NO POLICY, PRACTICE, PROCEDURE, STATEMENT, OR ACTION OF THE COMPANY, OR OF ANY INDIVIDUAL AT THE COMPANY, MAY ALTER, MODIFY, OR WAIVE THE “ATWILL” NATURE OF EMPLOYMENT WITH THE COMPANY IN ANY WAY OR AT ANY TIME.

I ALSO UNDERSTAND THAT IF I AM MADE A CONDITIONAL OFFER OF EMPLOYMENT, I WILL BE REQUIRED TO AUTHORIZE AND PASS A BACKGROUND SCREENING, AUTHORIZE AND PASS A DRUG SCREENING, AND PRESENT EVIDENCE OF MY U.S. CITIZENSHIP OR PROOF OF MY LEGAL RIGHT TO LIVE AND WORK IN THIS COUNTRY.

I HEREBY REPRESENT AND WARRANT THAT I HAVE READ AND FULLY UNDERSTAND THE FOREGOING, AND THAT I HEREBY SEEK EMPLOYMENT UNDER ALL THE CONDITIONS STATED HEREIN.

Signature of Applicant

MM slash DD slash YYYY
Based in Prineville, Oregon serving clients throughout all of Central Oregon
Send us an email or give us a call 541-527-4342