APPLICATION FOR EMPLOYMENT

PERSONAL INFORMATION

First name

Last name

Address

City

State

Zip/Postal Code

Phone Number

Are You Able To Lift Up To 75lbs Without Help?

Yes

Are You Able To Start Your Shift At 5 AM?

Yes

Do You Have A Valid Driver's License?

Yes

Date Available To Start:

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The Company is an equal opportunity employer and does not discriminate in employment on account of race, color, religion, national origin, citizenship status, ancestry, age, sex (including sexual harassment), sexual orientation, genetic information, marital status, physical or mental disability, military status or unfavorable discharge from military service. I understand that neither the completion of this application nor any other part of my consideration for employment establishes any obligation for The Company to hire me. If I am hired, I understand that either The Company or I can terminate my employment at any time and for any reason, with or without cause and without prior notice. I understand that no representative of The Company has the authority to make any assurance to the contrary. I attest with my signature below that I have given to The Company true and complete information on this application to the best of my knowledge and I authorize The Company to verify the accuracy and to obtain reference information on my work performance. If any information I have provided is untrue, or if I have concealed material information, I understand that this will constitute cause for the denial of employment or immediate dismissal. (optional)

I agree that my typed name below will be as valid as a handwritten signature to the extent allowed by local law

Yes

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