Name *

First Name

Last Name

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone *

(###)

###

####

Are you legally authorized to work in the United States

Yes

No

Are you applying for: *

Full-time work

Part-time work

Temporary work (e.g. summer, holiday, project-specific work)

Would you be available to work overtime, if necessary?

Yes

No

If hired, on what date can you start? *

MM

DD

YYYY

Have you ever applied to work for Applied EarthWorks, Inc. previously? *

Yes

No

Do you have friends or relatives who work for Applied EarthWorks, Inc.? *

Yes

No

If hired, do you have a reliable means of transportation to and from work? *

Yes

No

Do you have a valid drivers license? *

Yes

No

If hired, can you present evidence of your U.S. citizenship or proof of your legal right to live and work in this country? *

Yes

No

Are you currently employed? *

Yes

No

If so, may we contact your current employer?

Yes

No

1) I hereby certify that I have not knowingly withheld any information that might adversely affect my chances for employment and that the answers given by me are true and correct to the best of my knowledge. I further certify that I, the undersigned applicant, have personally completed this application. I understand that any omission or misstatement of material fact on this application or any document used to secure employment shall be grounds for rejection of this application or for immediate discharge if I am employed, regardless of the time elapsed before discovery.

Yes

No

2) I hereby authorize the company to thoroughly investigate my references, work record, education and other matters related to my suitability for employment . In addition, I hereby release the company, my former employers and all other persons, corporations, partnerships and associations from any and all claims, demands or liabilities arising out of or in any way related to such investigation or disclosure.

Yes

No

3) I understand that in signing this Application for Employment that I agree to submit to binding arbitration any and all disputes and claims arising out of the submission of this application and by so doing am waiving my rights to legal adjudication. I acknowledge that I have been advised that I should seek outside counsel prior to signing this document since an agreement to binding arbitration requires an informed relinquishment of a known right. I have either sought outside counsel or consciously declined to do so.

Yes

No

4) I agree, in the event that I am hired by the Company, to abide by all established Company Policies and Procedures.

Yes

No

5) I understand that nothing contained in the application, or conveyed during any interview which may be granted or during my employment, if hired, is intended to create an employment contract between me and the company. In addition, I understand and agree that if I am employed, my employment is for no definite or determinable period and may be terminated at any time, with or without prior notice, at the option of either myself or the company, and that no promises or representations contrary to the foregoing are binding on the company unless made in writing and signed by me and the company’s designated representative.

Yes

No

5) I understand that nothing contained in the application, or conveyed during any interview which may be granted or during my employment, if hired, is intended to create an employment contract between me and the company. In addition, I understand and agree that if I am employed, my employment is for no definite or determinable period and may be terminated at any time, with or without prior notice, at the option of either myself or the company, and that no promises or representations contrary to the foregoing are binding on the company unless made in writing and signed by me and the company’s designated representative.

Yes

No

Date of Applicant's Electronic Signature *

(Please select today's date)

MM

DD

YYYY