MH EBY - Application

Application

If you are interested in being employed by EBY please fill out the application below. Thanks!

Last Name:

First Name:

Middle Name:

Address:

Email:

Phone:

Referred By:

Are you 18 or older?: Yes

Position:

Date you can Start:

Salary Desired:

Are you currently employed?: Yes

May we inquire of your present employer?: Yes

Ever applied to this company before?: Yes

Where?:

When?:

Education	Name and Location of School	Years Completed	Did you Graduate?
Grammer School:			Yes
High School:			Yes
College:			Yes
Additional Education:			Yes
Subjects Studied:
Job Related Skills:
Activites:

Former Employers
Dates	Name and Address of Employer	Salary	Position	Reason for Leaving
From: To:
From: To:
From: To:
Which of these jobs did you like best, why?:
Which of these jobs did you like least, why?:

References
Name	Phone Number	Business	Years Knonw

Authorization

I certify that all the information submitted by me on this application is true and complete and to the best of my knowledge and I understand that if any false information, omissions, or misrepresentations are discovered, my application may be rejected and, if I am employed my employment may be terminated at any time.

I understand that any employment is conditioned on a background check. I authorize M.H. Eby, inc. to thoroughly investigate all statements contained in my application and resume, and I authorize my former employers and references to disclose information regarding my former employment, character and general reputation to M.H. Eby, Inc., without giving me prior notice of such disclosure. I release M.H. Eby, Inc., any former employers and all references listed above from any and all claims, demands or liabilities arising out of or related to such investigation or disclosure.

I understand and agree that nothing contained in this application or conveyed during any interview is intended to create an employment contract. I further understand and agree that if I am hired my employment will be “at will” and without fixed terms and may be terminated at any time with or without cause and without prior notice at the option of either myself or the Company. No promises regarding employment have been made to me and I understand that no such promise or guarantee is binding upon the Company unless made in writing.

If I am offered employment I agree to submit to a medical examination and drug test before starting work. If employed, I also agree to submit to a medical examination or drug test at any time deemed appropriate by M.H. Eby, Inc. and as permitted by law. I consent to such examinations and tests, and I request that the examining doctor disclose to M.H. Eby, Inc. the results of the examination, which results shall remain confidential and separate from my personnel file. I understand that my employment and continued employment, to the extent permitted by law, is contingent upon satisfactory medical examinations and drug test and if I am hired a condition of my employment will be that I abide by the company’s Drug and Alcohol policy.

I understand that filing out this form does not indicate there is a position open and does not obligate the Company to hire. If hired, I agree to abide by all Company work rules, policies and procedures. M.H. Eby, Inc. retains the right to revise its policies or procedures, in whole or in part, at any time.

Signature:

Date: