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EMPLOYMENT APPLICATION

This Agency is an equal opportunity employer. Federal and State laws prohibit discrimination of employment because of race, color, religion, age, sex, Nation al origin or disability. No questions on this application is asked for the purpose of limiting of excluding any applicant's consideration for employment because of race, color, religion, age, sex, National origin or disability

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APPLICATION DISCLOSURE

PLEASE READ THIS STATEMENT CAREFULLY. SHOULD YOU HAVE QUESTIONS, PLEASE SEEK ASSISTANCE BEFORE SIGNING TRE APPLICATION THIS COMPANY IS AN EQUAL OPPORTUNITY EMPLOYER AND SELECTS INDIVIDUALS BEST MATCHED FOR THE JOB BASED UPON JOB-RELATED QUALIFICATIONS REGARDLESS OF RACE, COLOR. CREED, SEX RELIGION. NATIONAL ORIGIN. AGE OR DISABILITY. 1 UNDERSTAND THAT ANY MISREPRESENTATION. MISINFORMATION OR INACCURACY OF THE STATEMENTS CONTAINED IN APPLICATION MAY RESULT IN TERMINATION OF MY EMPLOYMENT OR WITHDRAWAL OF AN OFFER OF EMPLOYMENT. I AUTHORIZE THE COMPANY TO INVESTIGATE INFORMATION AND REFERENCES AND TO OBTAIN ANY TRANSCRIPTS, RECORDS. OR DOCUMENTS PERTAINING TO MY BACK GROUND AND BUSINESS EXPERIENCE • REQUIRED TO ARRIVE AT AN EMPLOYMENT DECISION. I ALSO HEREBY RELEASE INCURRED BY MYSELF IN OBTAINING SUCH INFORMATION.

I UNDERSTAND THAT IF I HAVE A PHYSICAL OR MENTAL IMPAIRMENT THAT SUBSTANTIALLY LIMITS ONE OR MORE OF MY MAJOR LIFE ACT. I CAN ADVISE THE COMPANY AT ANYTIME DURING THE APPLICATION, INTERVIEW OR HIRING PROCESS ABOUT THE ACCOMODATIONS THE COMPANY COULD MAKE ME ENABLE TO PERFORM THE ESSENTIAL FUNCTIONS OF THE JOB I AM SEEKING. I UNDERSTAND THAT SUBMISSION OF INFORMATION REGARDING REASONABLE ACCOMODATION IS VOLUNTARY AND THAT MY REFUSAL TO PROVIDE IT WILL NOT SUBJECT ME TO ADVERSE TREATMENT IN THE EMPLOYMENT PROCESS. I FURTHER UNDERSTAND THAT INFORMATION OBTAINED BY THE COMPANY REGARDING MY DISABILITY WILL BE KEPT CONFIDENTIAL EXCEPT THAT IF I AM HIRED, (1 SUPERVISORS AND MANAGERS MAY BE INFORMED REGARDING RESTRICTIONS ON MY WORK OR' DUTIES. AND REGARDING NECESSARY ACCOMMODATIONS; (2) FIRST AD SAFETY PERSONNEL MAY BE INFORMED, WHEN AND TO THE EXTENT APPROPRIATE. IF TIE CONDITION MIGHT REQUIRE EMERGENCY TREATMENT: AND GOVERNMENT OFFICIALS INVESTIGATING COMPLIANCE WITH THE AMERICANS DISABILITIES ACT MAY BE INFORMED. IN THIS CONNECTION, I AUTHORIZE ANY PHYSICIAN OR HOSPITAL TO RELEASE TO THE COMPANY ANY INFORMATiON THAT MAY BE ECESSARY TO DETERMINE MY ABILITY TO PERFORM TEE ESSENTIAL FUNCTIONS OF A JOB FOR WHICH I AM BEING CONSIDERED PRIOR TO OR DURINNG MY EMPLOYMENT WITH THE COMPANY IF OFFERED EMPLOYMENT THE COMPANY MAY REQUIRE TO TAKE A PHYSICAL EXAMINATION AND DRUG AND ALCOHOL SCREEN THE PESULTS OF WHICH I AGREE CAN BE REPORTED TO THE COMPANY.

I HEREBY UNDERSTAND ACKNOWLEDGE THAT UNLESS OTHERWISE DEFINED BY APPLICABLE LAW, ANY EMPLOYMENT RELATION SUM WITH THIS ORGANIZATION IS OF AN WILL" NATURE: MEANS THAT THE EMPLOYEE MAY RESIGN AT TIME AND T}-E ElviPLOYER MAY DISCHARGE EMPLOYEE AT ANY TIME WITH OR WITHOUT CAUSE. IT FURTHER UNDERSTOOD THAT THIS -AT WII-LOCALLY ACKNOWLEDGED (N BY AN AUTHORIZED EXECUTIVE OF THIS ORGANIZATION. IF HIRED. AGREE To TO THE RULES AND REGULATIONS OF THIS COMPANY AS ISSUED FROM TO TIME.
EMPLOYMENT REFERENCES
EMPLOYMENT REFERENCES

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