*Answering "YES" to these questions does not constitute an automatic bar to employment. Factors such as date of the offense, seriousness and nature of the violation, rehabilitation and position applied for will be taken into account.
Summarize any additional training & skills. Include licenses & certificates that relate to the functions of the position for which you are applying.
**High School, College, Other. Please list Name, Location, years completed, and if graduated. Also, list course of study.
**Please list Name, Relationship, Telephone, and # of Years Known
I hereby declare the information provided by me in this application is true and complete, and I understand that falsification of this information is grounds for refusal to hire or, if I've been hired, for termination. I authorize any of the persons or organizations referenced in this application to give you and any of them all information concerning my previous employment, education, or any other information they might have, personal or otherwise, with regard to any of the subjects covered by this application, and I release all such parties from liability for any damage which may result from furnishing such information to you. I further acknowledge that if the employer employs me, my employment will be "at-will", and may be terminated with or without cause at any time by me or by Cottle's Asphalt Maintenance, Inc. I understand that no representative of the company has any authority to enter into any agreement for employment for any specified period of time or to assure any benefits or terms and conditions of employment, either prior to commencement of the employment or after I have become employed. I consent to a drug test, either prior to commencement of employment or after I become employed, if deemed necessary by the employer.
I certify that I have read, fully understand and accept all terms of the foregoing Applicant Statement.