ARE YOU LEGALLY ELIGIBLE FOR EMPLOYMENT IN THE U.S.A. ?
I AM SEEKING A PERMANENT POSITION:
Are you able to perform the essential functions of the position with or without accommodations?
IF NECESSARY FOR THE JOB I AM ABLE TO:
Provide a valid Drivers License?
MAY WE CONTACT YOUR PREVIOUS SUPERVISOR FOR A REFERENCE:
List last employment first. Include summer or temporary jobs. Be sure all your experience or employers related to this job are listed here.
Are you 18 years or older (required for compliance with child labor laws)? If no, can you furnish a work permit if required?
No, but have work permit
Have you been convicted of a criminal offense?
For the purposes of this question, minor traffic offenses, infractions or citations, misdemeanors, expunged, or annulled convictions (including juvenile convictions or adjudications of delinquency), should not be included or considered. A conviction will not necessarily disqualify you from employment; the Company will consider additional factors including, but not limited to, the relationship between the conviction and the position applied for.
Have you been previously employed by us?
Are you related to an employee of the company?
How were you referred to us?
Additional skills including supervision skills, other languages, or information regarding the career/occupation you wish to bring to the employer's attention:
PLEASE READ ALL OF THE FOLLOWING CAREFULLY
I understand and agree that if I am offered employment, the offer will be conditioned upon the results of a medical examination which includes a drug test and that failure or refusal to take such test will disqualify me from further consideration for employment with Midstate Berkshire.
I understand and agree that if I am hired, my employment with Midstate Berkshire will be terminable "at-will". As an at-will employee, I understand and agree that I have the right to terminate my employment with the Company at any time, for any reason, with or without notice, with or without cause, and that the Company retains the same rights. If I am hired, I understand that all benefits, policies and procedures may be changed by the Company at any time, with or without notice. I understand that this application form, any and all policies, practices, and procedures of the Company, and all other communications provided or distributed to me by the Company, whether written or verbal, before hire or after I am employed, do not constitute or supplement any contract of employment. I further understand that no agent, employee, or representative of the Company has the authority to make any promise or agreement contrary to the foregoing, unless it is in writing and signed by an authorized executive officer of Midstate Berkshire.
I authorize the Company to investigate, verify and discuss all information set forth in my application, by contacting my prior employers and other references set forth above, and by any and all other means authorized or permitted by law, including any consumer and criminal background checks. I authorize the Company to request and obtain job-related information such as consumer reports, credit reports, investigative reports, and motor vehicle driving records, and make any other inquiries as to my character, reputation and ability as necessary for the Company to consider and evaluate my application for employment. I authorize any entity or person named in this application to provide the Company with any and all information in their possession, custody, or control regarding me, whether or not it is in their records, and to provide the Company with information that may be requested by the Company to arrive at an employment decision. I hereby release and agree to hold harmless the Company and its employees and agents from any and all claims that may arise as a result of taking any actions described herein. In addition, I hereby release and agree to hold harmless any and all individuals and entities who provide any information concerning me whether orally or in writing, in response to a request for such information from the company. A photocopy of this authorization shall be deemed as valid as the original.
If I am employed by Midstate Berkshire I will comply with all policies, rules and regulations implemented by the Company. I recognize that violation or non-compliance with any such policies, rules and regulations, or inappropriate or improper conduct or performance, may result in discipline up to and including termination of employment.
I hereby certify that the facts set forth above in my employment application are true and complete to the best of my knowledge. I understand that any omissions or false or misleading statements in this application or in interviews or other aspects of the hiring process will be grounds for my immediate disqualification from further consideration for employment or, if already employed, such information will be grounds for the immediate termination of my employment.
I understand and agree that the authorizations and agreements set forth above apply to Midstate Berkshire and its successors.
I have read the above and understand it.