Work History
Note: Account for your entire employment history (most recent first including periods of self-employment).
Employer #1
Employer #2
Employer #3
Employer #4
Education
High School
College
Graduate School
The Companies will work with an otherwise qualified individual to reasonably accommodate his or her disability. Job applicants should direct all requests for accommodations to Human Resources.
Immigration Reform and Control Act (IRCA)
The Immigration Reform and Control Act (IRCA) prohibits the employment of unauthorized aliens and further requires that if you are hired, the Company must verify your identity and your authority to work in the United States, even if you are a U.S. citizen. You are responsible for obtaining and providing the documentation required to perform the verification. (Information concerning this verification procedure and requirements is available upon request.)
REFERENCES
Provide the names and contact information for three professional or equivalent references whom you have known for at least three years and are familiar with your work performance. References should not include immediate or extended family. Equivalent references can include academic references, such as professors, mentors, counselors, or advisors. Two references must be or have been individuals to whom you reported directly or provide the reason you cannot provide two supervisory references. Be aware that we will be contacting the references you have chosen to list below.
I certify that all the information I have provided on this application is true and complete to the best of my knowledge. I understand that omitting requested information or giving false or misleading information on my application (even if I believed the information to be true), in my interview(s), or in the process of my pre-employment evaluation may result in rejection of my application or termination of employment. I authorize the Company to verify the information I have provided in this application and, if I am hired, I authorize continuing investigation of all statements contained in this application, consistent with applicable law.
I understand that employment and continued employment is subject to satisfactory completion of a background check and proof of my authorization to work in the United States, all conducted and/or required in accordance with applicable laws. Past conviction of a crime is not an automatic bar to employment. The nature, time since conviction, disposition of conviction and other factors deemed relevant by the Company for the position will be considered as it relates to the job you are seeking and consistent with applicable law. To the maximum extent permitted by law, I hereby release and hold harmless all persons and entities, including my present employer, requesting or supplying information about my background and, to the maximum extent permitted by law, I also release the Company and any contractor or vendor retained by the Company from all liability in connection with the conduct of a background check in connection with my application for employment.
Notwithstanding the foregoing, I understand that this Application of Employment does not constitute an offer of employment by the Company. Employment with the Company is for an indefinite and unspecified duration. If I am hired, I may leave employment at will, and the Company may discharge me or any or all other employees at any time, without notice, and for any reason not prohibited by law.
I agree that any claim or lawsuit relating to my application for employment and, if applicable, employment or termination from employment with the Company must be filed no more than six (6) months after the date of the employment action that is the subject of the claim or lawsuit. I waive any statute of limitation to the contrary to the maximum extent permitted by law.
FOR MASSACHUSETTS APPLICANTS: I ACKNOWLEDGE THAT IT IS UNLAWFUL IN MASSACHUSETTS TO REQUIRE OR ADMINISTER A LIE DETECTOR TEST AS A CONDITION OF EMPLOYMENT OR CONTINUED EMPLOYMENT. AN EMPLOYER WHO VIOLATES THIS LAW SHALL BE SUBJECT TO CRIMINAL PENALTIES AND CIVIL LIABILITY.
I acknowledge that I have carefully read all of the above, acknowledge and understand what I am signing. I understand that an electronic signature has the same effect and validity as a written signature.