Be sure to include Start Date, End Date, Name & Address, Telephone, Job Title, Department and the name of your supervisor.  Please describe your duties too.

Pre-Employment Statement:  By typing the word I AGREE in the box above, you certify that the answers given by you are true and correct without consequential omissions of any kind whatsoever.  You furthermore agree that the company shall not be liable in any respect if your employment is terminated because of falsity of statements, answers or omissions made by you in this application.  You also authorize the companies, schools or persons named above to give any information regarding your employment, character and qualifications together with any information they have regarding you whether or not it is in the records.  You hereby release said companies, schools or persons from liability for any damage for issuing this information.  You understand that any misleading or incorrect statements may render this application void, and if employed, would be cause for termination.  If there is an offer of employment, you understand that it is contingent upon passing a physical examination.  If employed you agree to wear protective clothing or devices as required by the company and to comply with the safety rules.  In consideration of your employment, you agree that your employment and compensation can be terminated with or without cause and with or without notice at any time at the option of either the company or yourself.