Application For Employment

Please fill out this form COMPLETELY. If you have questions or want more information please contact:
Nancy Crouch: 1-800-929-5519 ext. 2043 or Jeff Pence: 1-800-929-5519 ext. 2045

Personal Information













(If yes, verification will be required upon employment.)




Please list any experiences, skills, or qualifications which will be of special benefit in the job for which you are applying. (Applicant should not list any information that Federal and/or State law precludes obtaining in the pre-employment stage.)
Education / Elementary School



Education / High School



Education /College





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Education /Other





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Present and Past Employment/ Most Recent First






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Personal References (Not former Employers or Relatives)



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PLEASE READ BELOW AND ANSWER YES OR NO

The facts set forth in my application for employment are true and complete. I understand that if employed, any false statement on this application may result in my dismissal. I further understand that this application is not Intended to be a contract of employment, nor does this application obligate the employer in any way if the employer decides to employ me. I understand and agree that my employment is at-will and can be terminated by either party with or without notice, at anytime, for any reason or no reason. No one other than an officer of the Company has any authority to enter Into any agreement for employment for any specified period of time or to make any agreement contrary to the foregoing and then only in a writing signed by an officer.


To Applicant: READ THIS INTRODUCTION CAREFULLY BEFORE ANSWERING ANY QUESTIONS IN THIS BLOCKED-OFF AREA. The Civil Rights Act of 1964 prohibits discrimination in employment because of rade, color, religion, sex or national origin. Federal law also prohibits other types of discrimination such as age, citizenship, disability, veteran status, attainment of benefits, and participation in union activities. The laws of most states and many localities also prohibit some or all of the above types of discrimination as well as some additional types including, but not limited to, discrimination based upon ancestry, marital status, parental status, sexual orientation, or source of income. The Fair Credit Reporting Act imposes restrictions with respect to credit data. DO NOT ANSWER ANY QUESTION CONTAINED IN THIS BLOCKED-OFF AREA UNLESS THE EMPLOYER HAS CHECKED THE BOX NEXT TO THE QUESTION, thereby indicating that for the position for which you are applying the requested information is needed for a legally permissible reason including, without limitation, national security requirements, affirmative action, a bona fide occupational qualification or business necessity.



















(Excluding misdemeanors,summary,annulled, or expunged offenses sealed by a court. Conviction of a crime will not be an absolute bar to employment.)



You have been given a written job description listing the essential job functions of the position(s) for which you have applied. Please review the job description(s) and answer the following questions. (To review descriptions CLICK HERE)



Please review your application, then click the SEND button to submit.