Application for Employment

Are you legally authorized to work in the United States?
If you are under 18 years of age, do you have a work permit if required by applicable state law?

Is there anything that would prevent you from working any day or time of the week or regularly working overtime?
Have you ever been employed by us?
Have you ever applied for employment with us?
Do you have any friends, relatives, or acquaintances working for us?
How were you referred to this Company?
If hired, will you have reliable transportation to and from work?

Please list the names, telephone numbers, and email addresses of 3 personal references who have knowledge of your capability to perform the duties of the position you are seeking. Please exclude relatives.

Please list all prior employers, beginning with your PRESENT or MOST RECENT employer. Please upload additional sheets if necessary. Complete all requested information in full. Please include as part of your employment history any verified work performed on a volunteer basis and/or work performed while in the military.

Employer #1

Employer #2

Employer #3

Employer #4

Is there any reason why we should not contact any current or former employer for a reference?

To the extent required by applicable law, the Company maintains a smoke-free workplace.

Massachusetts Applicants: Note that it is unlawful in Massachusetts to require or administer a lie detector test as a condition of employment or continued employment. An employer who violates this law shall be subject to criminal penalties and civil liability.

Please read and e-sign the Applicant's Statement below.

Applicant's Statement

I have read and fully understand the questions asked in this application. I certify that all of the answers I have given are true, accurate and complete. I understand that the omission and/or misrepresentation of any fact from or on this application or during any interview will result in immediate rejection of my application or if I am hired will be cause for immediate dismissal. Unless I noted otherwise, I authorize the Company to independently contact all my employment references and personal references, as well as the education institutions I have attended. I further authorize the Company to independently inquire about, investigate and obtain copies of any records which relate to me from my former employers and educational institutions. I hereby release the Company and all affiliated persons and entities, as well as any person or institution that provides the Company with any lawful information about me, from any and all liability whatsoever resulting from any such lawful independent inquiry, investigation or communication.

If hired, I understand that I will be required to abide by all of the rules and regulations of the Company. I understand and agree that nothing in this application shall constitute an offer, a contract or a guarantee of employment for a specific period of time. If hired, I understand that my employment may be terminated with or without cause and with or without notice at any time, at the will of the Company or me. I further understand that no representative or agent of the Company, other than the Senior Vice President of Human Resources has the authority to enter into any agreement for employment, on an individual or collective basis, for any specific period of time, or to make an agreement contrary to the foregoing. I also understand that any agreement modifying at-will employment status, on an individual or collective basis, must be in writing and signed by the Senior Vice President of Human Resources. In addition, I understand that the Company and all plan administrators shall have the maximum discretion permitted by law to administer, interpret, modify, discontinue, enhance or otherwise change all policies, procedures, benefits or other terms and conditions of employment.


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