ALL POTENTIAL EMPLOYEES ARE EVALUATED WITHOUT REGARD TO RACE, COLOR, RELIGION, AND GENDER, NATIONAL ORIGIN, AGE, MARITAL OR VETERAN STATUS, THE PRESENCE OF A NON-JOB RELATED HANDICAP OR ANY OTHER LEGALLY PROTECTED STATUS.

Position Sought, you may list more than one.

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Name_____________________________________________________________ Date________________

Address__________________________________ City___________________ State or Country________ Zip_______

Home Phone ____________________Cell Phone ___________________Other Phone_________________

Email Address: ______________________________

 Have you ever been convicted of a felony? [    ] Yes [    ] No     If yes stop here.

 Country of citizenship. ____________________________________________________

 Do you have a passport? Yes [    ]   No [    ]

 What type of driver license do you hold? _________________________________________________
Driver License #'s__________________________________________________________

 Have you ever been involuntarily terminated or asked to resign from any position of employment? [    ] Yes [    ] No

 If selected for employment, are you willing to submit to a pre-employment drug screening test?       [    ] Yes           [    ] No

 Other training, certifications, or licenses held: ________________________________________________________________________________________________________________________________________________________________________________________________________________________

 What languages do you speak? ___________________________________________________

 What languages do you read? ____________________________________________________

 What country’s have you been in or live in? _____________________________________________________________________________

 List other information pertinent to the employment you are seeking: ______________________________________________________

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 EMPLOYMENT

(Most Recent First.)
1.  Employer_____________________________________________ Job Title_________________________

Dates Employed______________ Prior Position Held within Company (if any):  _________________________

Address_________________________________ City___________________ State________ Zip_________

Phone____________________ Job Title_______________________ Supervisor_______________________

Duties Performed _________________________________________________________________________

Reason for Leaving _______________________________________________________________________

2.  Employer_____________________________________________ Job Title_________________________

Dates Employed______________ Prior Position Held within Company (if any):  _________________________

Address_________________________________ City___________________ State________ Zip_________

Phone____________________ Job Title_______________________ Supervisor_______________________

Duties Performed _________________________________________________________________________

Reason for Leaving _______________________________________________________________________

3.  Employer_____________________________________________ Job Title_________________________

Dates Employed______________ Prior Position Held within Company (if any):  _________________________

Address_________________________________ City___________________ State________ Zip_________

Phone____________________ Job Title_______________________ Supervisor_______________________

Duties Performed _________________________________________________________________________

Reason for Leaving _______________________________________________________________________

4.  Employer_____________________________________________ Job Title_________________________

Dates Employed______________ Prior Position Held within Company (if any):  _________________________

Address_________________________________ City___________________ State________ Zip_________

Phone____________________ Job Title_______________________ Supervisor_______________________

Duties Performed _________________________________________________________________________

Reason for Leaving _______________________________________________________________________

ACKNOWLEDGMENT AND AUTHORIZATION

I certify that answers given herein are true and complete to the best of my knowledge.

I authorize investigation of all statements contained in this application for employment as may be necessary in arriving at an employment decision. 
This application for employment shall be considered active for a period of time not to exceed 45 days.  Any applicant wishing to be considered for employment beyond this time period should inquire as to whether or not applications are being accepted at that time.

I hereby understand and acknowledge that, unless otherwise defined by applicable law, any employment relationship with this organization is of an “at will” nature, which means that the Employee may resign at any time and the Employer may discharge Employee at any time with or without cause.  It is further understood that this “at will” employment relationship may not be changed by any written document or by conduct unless such change is specifically acknowledged in writing by an authorized executive of this organization.

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

I understand, that this is an all volunteer company and that I will be paid for my expenses in the recovery of hostages.

I understand, also, that I will be on a call list when need.

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Signature of Applicant                                                                Date