Employment Application

Security
(a) **This Security Section must be completed by all applicants, EXCEPT FOR THOSE APPLICANTS IN HAWAII. MASSACHUSETTS, AND THE CITY OF PHILADELPHIA, PA: Under Hawaii and Massachusetts state law and Philadelphia Bill 110111-A, an employer is prohibited from making written, pre-employment inquiries of an applicant about his or her criminal history. HAWAII, MASSACHUSETTS, AND PHILADELPHIA, PA APPLICANTS SHOULD NOT, AND MUST NOT, ANSWER ANY OF THE QUESTIONS IN THIS SECURITY SECTION. RATHER, HAWAII, MASSACHUSETTS, AND PHILADELPHIA, PA APPLICANTS SHOULD SKIP THIS SECTION ENTIRELY AND PROCEED DIRECTLY TO THE EMPLOYMENT HISTORY SECTION IN THIS APPLICATION. Florida applicants should complete this Security Section (a) AND section (b) below.

Have you ever been convicted of a felony or misdemeanor punishable by 6 months or more of incarceration within the last 7 years? (You do not need to disclose: convictions for misdemeanor marijuana-related offenses more than two years old; convictions that have been sealed, expunged, or legally eradicated (such as juvenile offenses); participation in a pre- or post-trial diversion program; a discharge under the Georgia First Offenders Program; or misdemeanor convictions for which probation was completed successfully or otherwise discharged and the case was dismissed.)
If yes, please describe.

Yes No

If yes, please describe the nature of the offense(s), the date and place of conviction, and the legal disposition of the case. Company will not deny employment to any applicant solely because the person has been convicted of a crime. The Company however, may consider the nature, date and circumstances of the offense as well as whether the offense is relevant to the duties of the position for which you are applying.

(b) For Florida applicants ONLY: an (1) Have you ever been a defendant in a civil action for intentional tort? (An intentional tort is a civil wrong resulting from intentional ac

Yes No

(2) If yes, please describe the nature of the intentional tort and the disposition of the action.

Employment History
Complete all job history regardless of resume attachment

Current Employment

Employment History # 2

Employment History # 3

References
List three people (other than relatives) who are in a position to evaluate your previous employment performance, preferably former supervisors pr people with whom you have worked. (if applying for a supervisory position, please include one sub-ordinate.)

Please read the information below carefully and then check the box to authorize. Sign and Date before submitting.

I authorize the Company to verify, in any manner, all statements made by me. The Company may, for example, interview former employers, co-workers, schools, references, or others and request information and supporting documentation such as transcripts and evaluations. I authorize any and all former employers, references, or educational institutions to release all information relevant to my employment or education to the Company, without giving me prior notice. I release from any liability or responsibility all persons, companies and corporations supplying any information in verifying my statements above, as well as the Company in connection with its obtaining such information for use in verifying my statements above. I shall preserve in strictest confidence all information regarding the business or customers of the Company that may be disclosed to me or come to my attention in the process of applying for a position with the Company. If employed by the Company, I agree to comply with the Company's policies and procedures, safety rules, and cooperate in any reasonable security investigation. I understand that I am not employed by or entitled to employment by the Company unless and until I have received and accepted a written offer of employment from a Company representative. I also understand that no other act of the Company, including the acceptance of my application for employment, the scheduling of interviews with me, or any oral or written statements of interest or encouragement, creates an employment relationship with me, and I will not rely on any such act of the Company. I understand that if I am employed by the Company, such employment is "at-will," which means that my employment and related compensation may be terminated at any time, with or without cause, and with or without advance notice by me or by the Company. I understand that any misrepresentation or omission of fact on this application, my resume, any supplementary materials submitted by me, and interview responses, may be cause for a refusal to hire me or the termination of employment at any time during the period of my employment. I have reviewed this application personally, and I agree that all statements I have made on this application, in my resume, and other supplementary materials submitted by me are true and correct. I have not knowingly withheld any information that might adversely affect my chance for employment.

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