Application

Personal Information

Name*

First Last

Email*

Phone

Address

City

State

ZIP

Drivers License Status*

Drivers License Number

job information

Intended Position*

Referred By

Available Start Date*

Salary Requirements*

Experience*

Employment History

Previous Employer

Past Pay

Previous Employer

Past Pay

Previous Employer

Past Pay

Have you ever been employed with this company before?*

Yes
No

If yes, when?

Do you have any friends or relatives employed by this company?*

Yes
No

Name

Relationship

Are you currently employed?*

Yes
No

May we contact your employer?*

Yes
No

Are you currently on “lay off” status and subject to recall?*

Yes
No

If you are under 18 years of age, can you provide proof of your eligibility to work? *

Yes
No

If hired, can you provide proof of U.S. citizenship or proof of your legal right to work in the U.S.? *

Yes
No

Are you able to perform all of the essential functions of the job for which you are applying with or without reasonable accommodation?*

Yes
No

If hired, are there any accommodations the company would need to provide so that you can perform all those essential functions and duties of the position being applied for? *

Yes
No

If yes, please explain.

If driving is a requirement of the position applied for, have you in the last 7 years been convicted of Driving Under the Influence “(DUI).” *

Yes
No
N/A

If hired, do you have a reliable means of transportation to and from work?*

Yes
No

If hired, would you be able to travel or work overtime as needed?*

Yes
No

Have you ever been convicted of a felony or misdemeanor? *

Yes
No

If yes, please explain.

policy agreement

Please read each statement closely and check each acknowledging your understanding.

Equal Employment Opportunity Statement*

This company is committed to the principles of equal employment opportunity and is committed to make employment decisions based on merit. We are committed to complying with all Federal, State and local laws providing for equal employment opportunities, as well as all laws related to terms and conditions of employment. The Company desires to maintain a work environment that is free of sexual harassment and discrimination due to race, religion, color, national origin, physical or mental disability, age or any other status protected by Federal, State or local laws. The Company will make reasonable efforts to accommodate those physical or mental limitations of an otherwise qualified employee unless undue hardship would result for the company.

Discrimination and Sexual Harassment Policy Statement*

If you are offered a position with the Company, you may be given a drug/alcohol test as a condition of employment. Your refusal to timely submit to a drug/alcohol test or your failure to pass such a test means you will not be employed by this company. Neither the collector of specimens nor the medical professional who reviews the test results will be a company employee. The test results will be kept confidential. The individual undergoing testing will not be directly observed while providing the specimen unless there are reasonable grounds to believe the individual may alter or substitute the specimen. Negative test results are required as a condition of employment.

Complete and Accurate Information*

I hereby certify that I have not knowingly withheld any information that might adversely affect my chances for employment and that the answers given by me are true and correct to the best of my knowledge. I further certify that I have personally completed this application. I understand that any omission or misstatement of material fact on this application, or any other document used to secure employment, shall be grounds for rejection of this application or for immediate discharge if I am employed, regardless of the time elapsed before discovery.

At-Will Employment*

I understand and agree that if I am employed, my employment will be “at-will”, which means that the Company may terminate the employment relationship at any time, with or without cause and with or without notice. Likewise, the Company will respect my right to terminate my employment at any time, with or without cause and with or without notice. I further understand that any prior representation, whether expressed or implied to the contrary is hereby superseded and that no promise or representation contrary to the foregoing is binding on the Company unless made in writing and signed by the Company’s president.

Testing Authorization*

If offered a position with the Company, I hereby agree to any legally permitted physical, psychological, skill, drug or medical test required by the Company as a condition of employment.

Investigation Authorization*

I authorize investigation into all statements and references contained in this application. Said investigation may include credit, driving, criminal

I HAVE READ AND UNDERSTAND THE ABOVE POLICY STATEMENTS AND AGREE TO BE BOUND BY THEM IF EMPLOYED BY THE COMPANY.*

Join the Pinnacle team.

Please complete the form below to be considered for a position.

Personal Information

job information

Employment History

policy agreement

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