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Page 5



In exchange for the consideration of my job application by ___________________ (hereinafter called “the
Company”), I agree that:
Neither the acceptance of this application nor the subsequent entry into any type of employment
relationship, either in the position applied for or any other position, and regardless of the contents of
employee handbooks, personnel manuals, benefit plans, policy statements, and the like as they may exist
from time to time, or other Company practices, shall serve to create an actual or implied contract of
employment, or to confer any right to remain an employee of , or otherwise to change in any
respect the employment-at-will relationship between it and the undersigned, and that relationship cannot be
altered except by a written instrument signed by the President /General Manager of the Company. Both the
undersigned and may end the employment relationship at any time, without specified notice
or reason. If employed, I understand that the Company may unilaterally change or revise their benefits,
policies and procedures and such changes may include reduction in benefits.
I authorize investigation of all statements contained in this application. I understand that the
misrepresentation or omission of facts called for is cause for dismissal at any time without any previous
notice. I hereby give the Company permission to contact schools, previous employers (unless otherwise
indicated), references, and others, and hereby release the Company from any liability as a result of such
I also understand that (1) the Company has a drug and alcohol policy that provides for preemployment
testing as well as testing after employment; (2) consent to and compliance with such policy is a condition of
my employment; and (3) continued employment is based on the successful passing of testing under such
policy. I further understand that continued employment may be based on the successful passing of job-
related physical examinations.
I understand that, in connection with the routine processing of your employment application, the Company
may request from a consumer reporting agency an investigative consumer report including information as to
my credit records, character, general reputation, personal characteristics, and mode of living. Upon written
request from me, the Company, will provide me with additional information concerning the nature and scope
of any such report requested by it, as required by the Fair Credit Reporting Act.
I further understand that my employment with the Company shall be probationary for a period of sixty (60)
days, and further that at any time during the probationary period or thereafter, my employment relation with
the Company is terminable at will for any reason by either party.

Signature of applicant__________________________________________ Date: ___________________

This Company is an equal employment opportunity employer. We adhere to a policy of making employment
decisions without regard to race, color, religion, sex, sexual orientation, national origin, citizenship, age or
disability. We assure you that your opportunity for employment with this Company depends solely on your

Thank you for completing this application form and for your interest in our business.

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