MDT Employment form

* At will Employment- I acknowledge that if hired, I will be an at-will employee; I will be subject to dismissal or discipline without notice or cause, at the discretion of the employer. I also understand that this means I am free to quit my employment at any time, for any reason, without notice. I understand that no representative of the company, other than the president, has authority to change the terms of an at-will employment and that any such change can occur only in a written employment contract

EMPLOYMENT DESIRED

Hourly rate/Salary desired

Are you currently employed?

Yes No

If so, may we inquire of your present employer?

How did you hear about us?

Walk- In Advertisement Referral Other

Have you ever worked for this company?

Yes No

Do you know anyone who works for our company?

Yes No

Name and location of school

Subjects studied/Major

College or University

Name and location of school

Subjects studied/Major

Trade, Business or Correspondence School

Name and location of school

Subjects studied/Major

EMPLOYMENT HISTORY Include your last seven (7) years of employment history, including periods of unemployment, starting with the most recent and working backwards in time. Incomplete information could disqualify you from further consideration.

Immediate supervisor and title

Summarize the nature of work performed and job responsibilities

Immediate supervisor and title

Summarize the nature of work performed and job responsibilities

Immediate supervisor and title

Summarize the nature of work performed and job responsibilities

Immediate supervisor and title

Summarize the nature of work performed and job responsibilities

Do you have any special skills, experience and/or training that would enhance your ability to perform the position applied for? If yes, explain.

Please list three professional references

Address, Phone, Email

Please read carefully before signing.

I certify that the facts contained in this application are true and complete to the best of my knowledge and I understand that if employed; falsified statements on this application shall be grounds for dismissal. I authorize investigation of all statements contained herein and the references and employers listed above to give you any and all information concerning my previous employment and any pertinent information they may have, personal or otherwise, and release the company from all liability for any damage that may result from utilization of such information.

I also understand and agree that no representative of the company has any authority to enter into any agreement for employment for any specific period of time, or to make an agreement contrary to the foregoing, unless it is in writing and signed by an authorized company representative.

This waiver does not permit the release or use of disability-related information in a manner prohibited by the Americans with Disability Act (ADA) and other relevant federal and state laws.

MDT Employment form

EMPLOYMENT APPLICATION

APPLICANT INFORMATION