Employment Application

Current positions:

Job locations:
705 Pleasant St. Lee MA 01238 MAP
2855 S. East Ave., Unit 7, Fresno CA 93725 MAP

Personal Information





Referred by:

Employment Desired


What hours/day(s) are you available or would you prefer?

Date you can start

Salary Desired

Are you employed? Yes No

Have you ever applied to us before? Yes No

Education History
Name & Location of School Years attended Did you Graduate?
Grammar School Y N
High School Y N
College Y N
Trade or Business School Y N
General Information

Subjects of Special Study/Research/Training/Skills

U.S. Military or Naval Service & Rank

Employment History

(List below last four employers, starting with last one first)

Name & Address of Employer Position Salary Reason for Leaving Dates of Employment
Name Address Business Years
Phone # Email

I certify that the facts contained in this application are true and complete to the best of my knowledge and 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 specified period of time, or to make any 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 or medical information in a manner prohibited by the Americans with Disabilities Act (ADA) and other relevant federal and state laws.

Date: Signature:
By entering your name, you acknowledge the authorization statement as shown above.