High School  
Did you Graduate   Yes  No
College(s) & Degrees
Job Related Certifications
Special Training

Previous Employer
Address
Telephone  
Name of Supervisor

Previous Employer  
Address
Telephone
Name of Supervisor

1) Why do you think you would be particularly good at the job you are applying for? Please explain.

2) Are you a US Citizen or are you lawfully authorized to work in the United States?

Yes  No

3) Did you make any agreements with your previous employer(s) in which you promised not to compete with any other companies after you left or in which you promised to keep information confidential? If yes, please explain and submit a copy of said agreement. If no, please skip to question 4.

Yes  No

4) Do you have any felony convictions? If Yes, explain.  Yes  No

5) Do you have a valid MA drivers License? Yes  No

6) Do you have a reliable vehicle? Yes  No

I certify that all information I provide during the job application process is true and complete,and I agree that any false information, misstatements, or omissions of fact are a basis not to hire me and/or terminate me whether discovered now or later. I authorize the company to verify any information provided and I release the company and my previous employers from any liability that may result from the job application process.

I understand that company forms, documents, letters, advertisements, and oral representations if any, do not constitute an employment contract or elements of an employment contract. I agree that the job is not for any specific period of time and that I am an employee at will if hired. I also agree to conform to the rules and regulations of the company and that as an employee at will the employment relationship may be terminated at any time without cause or for any reason by me or by my employer.

Signature
Date (mm/dd/yyyy)