Name *

First Name

Last Name

Phone Number *

(###)

###

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Are you legally allowed to work in the United States? *

Yes

No

Have you ever been convicted of a felony? *

Yes

No

Date Started *

MM

DD

YYYY

Employer's Phone Number *

(###)

###

####

May we contact this employer for a reference? *

Yes

No

Date Started *

MM

DD

YYYY

Employer's Phone Number *

(###)

###

####

May we contact this employer for a reference? *

Yes

No

Phone Number *

(###)

###

####

Phone Number *

(###)

###

####

Do you agree with the terms and conditions as stated below? *

I understand that, if employed, falsified statements of any kind or omissions of facts called for on this application shall be considered sufficient basis for dismissal. I understand that should an employment offer be extended to me and accepted that I will fully adhere to the policies, rules and regulations of employment of the Employer. However, I further understand that neither the policies, rules, regulations of employment or anything said during the interview process shall be deemed to constitute the terms of an implied employment contract. I understand that any employment offered is for an indefinite duration and at will and that either I or the Employer may terminate my employment at any time with or without notice or cause. Aqua Gifts is an equal opportunity employer and does not discriminate against otherwise qualified applicants on the basis of race, color, creed, religion, ancestry, age, sex, marital status, national origin, disability or handicap, or veteran status. I authorize Aqua Gifts to verify their accuracy and to obtain reference information on my work performance. I hereby release Aqua Gifts from any/all liability of whatever kind and nature which, at any time, could result from obtaining and having an employment decision based on such information.

Yes

No