Job Application Complete

JOB APPLICATION COMPLETE

RECITALS

WHEREAS, Employer desires to evaluate Applicant for employment for the position indicated below and may extend an offer of employment subject to the terms set forth in this document; and

WHEREAS, Applicant submits this completed application form and certifies the accuracy of the information provided and agrees to the employment terms described herein if an offer is made; and

WHEREAS, the parties intend that this document serve both as a job application and as an agreement memorializing certain pre-employment conditions, confidentiality obligations, and basic employment terms to be incorporated into any subsequent offer of employment.

APPLICANT INFORMATION

Date of Application:    Position Applied For:

ELIGIBILITY AND AUTHORIZATION

Are you legally authorized to work in the jurisdiction where the position is located? Yes No

Have you ever been convicted of a felony? (A conviction will not necessarily disqualify an applicant.) Yes No

EMPLOYMENT HISTORY

Provide most recent employers. Attach additional pages if necessary.

EDUCATION

REFERENCES

SCOPE OF WORK

Describe the primary duties, responsibilities, and reporting relationships applicable to the position. This description may be incorporated into any subsequent employment offer.

PAYMENT TERMS

Proposed Base Salary (if applicable):

Payment Schedule:

Late Payment or Overpayment Recovery: Employer may withhold or recover amounts overpaid in error in accordance with applicable law. If Applicant is engaged as an independent contractor, late fee for undisputed late payments:

TERM AND TERMINATION

Anticipated Start Date:

If applicable, Anticipated End Date:    Notice Period to Terminate by Either Party:

The parties acknowledge that employment may be at-will unless otherwise agreed in a separate written employment agreement. Any termination shall be carried out in accordance with applicable law and with respect for contractual notice periods set forth above.

CONFIDENTIALITY

Applicant acknowledges that during the course of evaluation and, if employed, performance of duties, Applicant may have access to proprietary, confidential, or trade secret information of Employer. Applicant agrees that such information shall not be disclosed or used except as required in the performance of duties. Applicant shall execute any additional confidentiality or nondisclosure agreement requested by Employer as a condition of employment.

GOVERNING LAW

This application and any subsequent offer of employment shall be governed by the laws of the jurisdiction indicated below, without regard to conflict-of-law principles.

ENTIRE AGREEMENT

This document, together with any expressly incorporated attachments and any subsequently executed written offer of employment, constitutes the entire agreement between Applicant and Employer with respect to the subject matter hereof and supersedes all prior understandings, representations, and agreements, whether written or oral. Any modification must be in writing and signed by both parties.

CERTIFICATIONS AND AUTHORIZATIONS

By signing below, Applicant certifies that the information provided in this application is true, complete and accurate to the best of Applicant's knowledge. Applicant authorizes Employer to verify information provided herein, contact references, and conduct background checks where permitted by law. Applicant understands that falsification or omission of material information may be grounds for disqualification from consideration or termination of employment.

ADDITIONAL INFORMATION

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