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PLEASE PRINT ALL INFORMATION REQUESTED EXCEPT SIGNATURE

APPLICATION FOR EMPLOYMENT

APPLICATIOS MAY BE TESTED FOR ILLEGAL DRUGS

PLEASE COMPLETE PAGES 1-5.

Name

Present address

Employment desired

TYPE OF SCHOOL

NAME OF SCHOOL

LOCATION (Complete mailing address)

NUMBER OF YEARS COMPLETED

MAJOR & DEGREE


PLEASE PRINT ALL INFORMATION REQUESTED EXCEPT SIGNATURE

APPLICATION FOR EMPLOYMENT

OFFICE ONLY




Please list two references other than relatives or previous employers.




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APPLICATION FOR EMPLOYMENT

MILITARY

Specialty

Date Entered

Discharge Date

Work Experience

Please list your work experience for the past five years beginning with your most recent job held. If you were self-employed, give firm name. Attached Additional sheets if necessary.




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PLEASE PRINT ALL INFORMATION REQUESTED EXCEPT SIGNATURE

APPLICATION FOR EMPLOYMENT

Work experience




PLEASE READ CAREFULLY

APPLICATION FORM WAIVER

In exchange for the consideration of my job application by E.M. Gray & Son, Inc. (hereinafter called “the Company”), I agree that:


Neither the acceptance of this application nor the subsequent entry into any type of employment relationship, either in the position

applied for or any other position, and regardless of the contents of employee handbooks, personnel manuals, benefit plans, policy

statements, and the like as they may exist from time to time, or other Company practices, shall serve to create an actual or implied

contract of employment, or to confer any right to remain an employee of E.M. Gray & Son, Inc., or otherwise to change in any

respect the employment-at-will relationship between it and the undersigned, and that relationship cannot be altered except by a

written instrument signed by the President /General Manager of the Company. Both the undersigned and E.M. Gray & Son, Inc. may

end the employment relationship at any time, without specified notice or reason. If employed, I understand that the Company may

unilaterally change or revise their benefits, policies and procedures and such changes may include reduction in benefits.


I authorize investigation of all statements contained in this application. I understand that the misrepresentation or omission of facts

called for is cause for dismissal at any time without any previous notice. I hereby give the Company permission to contact schools,

previous employers (unless otherwise indicated), references, and others, and hereby release the Company from any liability as a

result of such contract.


I also understand that (1) the Company has a drug and alcohol policy that provides for preemployment testing as well as testing after

employment; (2) consent to and compliance with such policy is a condition of my employment; and (3) continued employment is

based on the successful passing of testing under such policy. I further understand that continued employment may be based on the

successful passing of job-related physical examinations.


I understand that, in connection with the routine processing of your employment application, the Company may request from a

consumer reporting agency an investigative consumer report including information as to my credit records, character, general

reputation, personal characteristics, and mode of living. Upon written request from me, the Company, will provide me with additional

information concerning the nature and scope of any such report requested by it, as required by the Fair Credit Reporting Act.


I further understand that my employment with the Company shall be probationary for a period of sixty (60) days, and further that at

any time during the probationary period or thereafter, my employment relation with the Company is terminable at will for any reason

by either party.

This Company is an equal employment opportunity employer. We adhere to a policy of making employment decisions without regard to race, color, religion, sex, sexual orientation, national origin, citizenship, age or disability. We assure you that your opportunity for

employment with this Company depends solely on your qualifications.


Thank you for completing this application form and for your interest in our business.

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POST EMPLOYMENT INFORMATION FORM

PERSON TO BE NOTICED NOTIFIED IN CASE OF EMERGENCY

FOR INSURANCE PURPOSES ONLY: LIST ALL DEPENDENTS



NAME

RELATIONSHIP

BIRTH DATE

SSN

TO BE COMPLETED

BY EMPLOYER

Applicant Selection Criteria Record

JOB TITLE

CANDIDATES CONSIDERED (INCLUDING MINORITIES AND FEMALES)

NAME

MALE/FEMALE

ETHNIC CODE*

ON LAB SECTION/OFF LAB

*ETHNIC CODES: 1-BLACK, 2-ORIENTAL, 3-HISPANIC, 4-AMERICAN INDIAN, 0-OTHER

CANDIDATE SELECTED

NAME

MALE/FEMALE

ETHNIC CODE

SOURCE

SELECTION CRITERIA

REASONS CANDIDATE SELECTED WAS PREFERABLE TO OTHERS

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