Application Information
Name (last,first,middle):
Address (Street,City,State,Zip):
Email Address:
Telephone Number:	(day) (Evening)
Are you at least 18 years old?
Are you legally authorized to work in the U.S.? If hired you will be required to provide proof of identity and work authorization.
Job Interest
Position applied for:
Shift preference:
	Part time days/hours preference:
How soon could you start?
Are you available to work overtime?
Our company is committed to a policy of nondiscrimination and equal opportunity for all employees and qualified applicants without regard to race, color, religious creed, national origin, ancestry, sex, age, disability, veteran's status,sexual orientation, or any other characteristic protected by law.

Education and/or Military Training
High School
School Name, City and State:
Major Subject(s):
Years Attended:	Diploma or Degree Received? Type:

College
School Name, City and State:
Major Subject(s):
Years Attended:	Diploma or Degree Received? Type:

Graduate
School Name, City and State:
Major Subject(s):
Years Attended:	Diploma or Degree Received? Type:

Other (Please specify)
School Name, City and State:
Major Subject(s):
Years Attended:	Diploma or Degree Received? Type:

Training Courses
Describe any relevant training programs you have completed. Include the types of training, the sources of the training, and the dates of the training


Employment History
List all employment and include any performed on a volunteer basis which can be verified, starting with present or most recent. If presently employed, may we contact your employer as a reference?

Company 1 Name, Address, Phone:
Dates of Employment from/to:
Salary History starting/final:
Reason for leaving:
Immediate Supervisor:
Position(s) held:

Company 2 Name, Address, Phone:
Dates of Employment from/to:
Salary History starting/final:
Reason for leaving:
Immediate Supervisor:
Position(s) held:

Company 3 Name, Address, Phone:
Dates of Employment from/to:
Salary History starting/final:
Reason for leaving:
Immediate Supervisor:
Position(s) held:

Company 4 Name, Address, Phone:
Dates of Employment from/to:
Salary History starting/final:
Reason for leaving:
Immediate Supervisor:
Position(s) held:

Qualifications
Briefly describe the type of work for which you are best qualified. Note any details about your qualifications which should be considered. Include special skills such as machines operated, licenses, foreign languages, computer and software knowledge etc.

What are your career objectives?

List any professional affiliations, honors and awards, publications, patents, etc. (Exclude any memberships which would reveal age, sex, race, religion, color, national origin, or disability.)

Please read the following statements; they constitute the conditions under which you would be employed by our Company should you be accepted for employment. I certify that all information that I have provided on this application is true and complete to the best of my knowledge. I understand that falsification, misrepresentations or omission of facts called for in this application may result in denial of employment or immediate dismissal. I understand that if I am employed by the Company, my employment is for no definite term and that I can be terminated at any time with or without notice and with or without cause. I further understand that no verbal promises or guarantees are binding on the Company and that no one, other than the President of the Company, has authority to enter into an agreement for employment contrary to the above, and that any such agreement must be in writing. If employed, I agree to abide by all of the Company's rules and regulations, and any changes thereto. I understand that a job offer may be contingent upon the satisfactory results of a physical examination and/or drug screening. (Note: You will be notified if these are a requirement, and all related expenses are paid by the Company.) I give the Company permission to investigate all pertinent information concerning my application in order to determine my qualifications for employment. I understand that any offer of employment may be rescinded if the results of the investigation are unacceptable to the Company.
Massachusetts General Laws c.149s19B requires that the following statement be included on employment application: "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." Massachusetts General Laws c.151B defines "genetic information" as any written record or explanation of a genetic test of a person's family history with regard to the presence, absence or variation of a gene. A genetic test is broadly defined as "any test of DNA,RNA, mitochondrial DNA, chromosome or proteins for the purpose of identifying genes or genetic abnormalities." The law expressly excludes drug and alcohol tests from this definition, meaning that employers may continue to conduct such tests in accordance with existing legal requirements. These new statutory provisions specifically prohibit employers from (1) terminating or refusing to hire individuals on the basis of genetic information; (2) requesting genetic information concerning employees, applicants or their family members; (3) attempting to induce individuals to undergo genetic tests or otherwise disclose genetic information; (4) using genetic information in any way that affects the terms and conditions of an individuals employment; or (5) seeking, receiving or maintaining genetic information for any non-medical purpose.