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Employment Application
Name and Location # of Years Completed Major Area of Study Degree/Diploma
High School
College
Technical or Certificate Programs

Please provide the following information for your previous three employers, beginning with the most recent (Do not use “see attached resume”). If you do not have any previous employment please select the "No Previous Employment History" option above.

From: To:
Dates Employed #1:
Start: Finish:
Weekly Pay:
From: To:
Dates Employed:
Start: Finish:
Weekly Pay:
From: To:
Dates Employed:
Start: Finish:
Weekly Pay:

(Please include skills, special training, etc.)

Name Address Phone # Relationship/Occupation Years Known
Reference #1
Reference #2
Reference #3

Please list names of supervisors, managers, or others who can comment directly on your abilities.

I authorize you to make such investigations and inquiries of my personal, employment, financial or medical history and other related matters as may be necessary in arriving at an employment decision. (Generally, inquiries regarding medical history will be made only if and after a conditional offer has been extended.) I hereby release employers, schools, healthcare providers and other persons from all liability in responding to inquiries and releasing information in connection with my application

In the event of employment, I understand that false or misleading information given in my application or interview(s) may result in discharge. I also understand that I am required to abide by all rules and regulations of the Company.

PolyJohn Enterprises conducts pre-employment screening. All offers are contingent upon successful completion of a controlled substances test and/or physical examination.

PolyJohn Enterprises is an Equal Opportunity Employer. It is the policy of PolyJohn Enterprises not to discriminate in employment matters on the basis of race, creed, color, age, marital status, national origin, sex, or status with regard to public assistance or disability.

PolyJohn Enterprises will comply with its obligation to provide reasonable accommodation to qualified individuals with disabilities

I have read and reviewed the information provided in this application. I certify that the information contained in the application is true and complete to the best of my knowledge and understand that if employed, falsified statements may result in termination.

I understand and agree that, if hired, my employment is at-will. This means that if I am hired, either the Company or I can end the employment relationship at any time for any or no reason.

If you have a resume to submit upload it here.