Employment Opportunity Application

EMPLOYMENT OPPORTUNITY APPLICATION

This Employment Opportunity Application (the Application) is entered into on this date by and between Applicant Name: with address at (Applicant) and Employer Name: with principal place of business at (Employer).

RECITALS

WHEREAS, Applicant has submitted information and seeks consideration for employment with Employer for a specified position and Applicant represents that the information provided is true, complete and accurate to the best of Applicant’s knowledge;

WHEREAS, Employer seeks to gather information reasonably necessary to evaluate Applicant’s qualifications, including but not limited to education, employment history, references and background screenings, and requires Applicant’s consent to obtain such information;

WHEREAS, Employer and Applicant desire to set forth the terms under which Applicant’s qualifications will be evaluated and the rights and obligations of each party in connection with consideration for employment.

NOW, THEREFORE, in consideration of the mutual promises and covenants contained herein, the parties agree as follows:

1. POSITION AND AVAILABILITY

Position Applied For: . Desired Compensation: $ per year (or state hourly). Available Start Date: .

2. APPLICANT INFORMATION

3. AT-WILL STATUS AND NO GUARANTEE

Applicant acknowledges and agrees that any offer of employment by Employer, if made, will not constitute a contract for a definite term unless expressly stated in a written employment agreement signed by both parties. Employment is and shall remain at-will, meaning either party may terminate the employment relationship at any time, with or without cause and with or without notice, except as may be expressly provided in a separate written agreement signed by Employer and Applicant.

4. BACKGROUND INVESTIGATION AND CONSUMER REPORTS

Applicant understands that Employer may obtain consumer reports, criminal background checks, motor vehicle records, employment and education verifications and other investigative reports as permitted by law to the extent necessary for employment screening. Applicant authorizes Employer and its agents to obtain such reports and to contact prior employers, educational institutions and listed references.

Consent to Background Check: I consent to the procurement of investigatory and consumer reports for employment purposes and understand that my eligibility for employment may be contingent on the results.

5. CERTIFICATIONS AND REPRESENTATIONS

Applicant certifies that all statements made in this Application and any attachments are true, complete and correct. Applicant understands that any false, misleading or omitted information may disqualify Applicant from consideration or result in termination if discovered after hire.

Conviction Disclosure: Have you ever been convicted of a felony (in this jurisdiction or elsewhere)? Check if yes:

6. PRE-EMPLOYMENT CONDITIONS

Applicant understands that employment may be conditioned upon successful completion of drug and alcohol testing, proof of identity and eligibility to work, and any certifications required for the position. Applicant authorizes Employer to require such testing and to rely on results in making employment decisions.

I am legally authorized to work in the United States: (check if true)

7. REASONABLE ACCOMMODATION

If Applicant requires a reasonable accommodation in the application or hiring process because of a disability, Applicant should describe the requested accommodation below. Employer will engage in an interactive process in accordance with applicable law to consider reasonable accommodations.

8. DATA USE, CONFIDENTIALITY AND RECORDS

Applicant acknowledges that personal data collected in connection with this Application will be used by Employer for evaluation, recruitment and compliance purposes and will be retained and disposed of in accordance with Employer’s records retention policies and applicable law. Applicant authorizes Employer to store and process the data provided herein and to share such data with third parties engaged to perform background checks or other services on behalf of Employer.

9. NOTICES

All notices required or permitted under this Application shall be in writing and delivered to the parties at the addresses set forth above or to such other address as either party may designate by written notice in accordance with this section. Notice is effective upon personal delivery, or, if mailed, three business days after deposit in the United States mail, postage prepaid, and addressed as provided below.

10. AMENDMENT; WAIVER; COUNTERPARTS

This Application may be amended only by a written instrument signed by both parties. No waiver of any provision shall be effective unless in writing and signed by the party granting the waiver. This Application may be executed in counterparts, each of which shall be deemed an original, and all of which together shall constitute one and the same instrument.

11. GOVERNING LAW; ENTIRE AGREEMENT; SEVERABILITY

This Application shall be governed by and construed in accordance with the laws of the state specified by Employer in its Notice Address, without regard to conflict of laws principles. This Application, together with any attachments and representations made by Applicant, constitutes the entire agreement between the parties with respect to the subject matter hereof and supersedes all prior or contemporaneous understandings and agreements. If any provision of this Application is held invalid or unenforceable, the remaining provisions shall continue in full force and effect.

12. ACKNOWLEDGMENT AND AUTHORIZATION

By signing below, Applicant acknowledges receipt of this Application, certifies the truthfulness of all information provided, and authorizes Employer to verify any statements contained herein and to obtain consumer and investigative reports as described above. Applicant further understands that completion of this Application does not guarantee an offer of employment.

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