Job Application Revised Form

JOB APPLICATION REVISED FORM

RECITALS

This Job Application and Applicant Acknowledgment (the "Application") is submitted by Applicant Name: to Employer Name: .

WHEREAS, Applicant seeks consideration for employment or engagement in the position identified below and has provided the information set forth in this Application for the purpose of evaluating Applicant's qualifications; and

WHEREAS, Employer is willing to consider Applicant subject to Employer's hiring policies, verification of the information herein, and the terms and conditions set forth in this Application, including confidentiality and authorization clauses.

APPLICANT INFORMATION

Desired Start Date:   Are you legally authorized to work in the jurisdiction of employment? Yes No

EDUCATION

EMPLOYMENT HISTORY (Most Recent First)

REFERENCES

SCOPE OF WORK (IF OFFERED EMPLOYMENT)

If offered employment, the general duties and responsibilities expected of the position are described below. This description does not create a contract for continued employment and duties may be modified by Employer in its discretion.

COMPENSATION / PAYMENT TERMS

Compensation Amount (annual or hourly as applicable):

Pay Schedule:   First Pay Date (if known):

Late Payment Administrative Fee: In the event Employer fails to timely deliver wages due to administrative error, Employer agrees to remit an administrative late payment fee of subject to applicable law and deductions. This fee is not intended to modify statutory wage payment obligations.

TERM AND TERMINATION

Anticipated Start Date:   Anticipated End Date (if temporary):

Either party may terminate employment at will, unless otherwise agreed in a separate written agreement. Where a fixed-term engagement applies, notice of termination by either party shall be provided in writing at least days prior to the intended termination date.

CONFIDENTIALITY

Applicant acknowledges that, if employed, Applicant may receive or create confidential, proprietary, or trade secret information. Applicant agrees that Applicant will not disclose or use such information except as required in the performance of assigned duties and in accordance with any separate confidentiality or non-disclosure agreement executed with Employer.

Applicant Initials:

GOVERNING LAW

This Application and any resulting employment relationship shall be governed by and construed in accordance with the laws of the state of , without regard to conflict of law principles, except where mandatory federal law applies.

ENTIRE AGREEMENT

This Application, together with any written offer, confidentiality agreement, or other executed agreements, constitutes the entire agreement between Applicant and Employer regarding the subject matter herein and supersedes all prior understandings, representations, and agreements, whether written or oral, except as otherwise expressly provided in a separate written contract executed by both parties.

AUTHORIZATION, CERTIFICATION, AND AT-WILL ACKNOWLEDGMENT

Applicant certifies that the information provided in this Application is true and complete to the best of Applicant's knowledge. Applicant authorizes Employer to verify any information provided, to contact listed references and prior employers, and to obtain background checks where permitted by law. Applicant understands that any false statements or omissions may result in denial of employment or termination. Applicant further acknowledges that, unless a separate written contract states otherwise, employment with Employer is at-will and may be terminated by either party at any time, with or without cause or notice.

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