Equal access to programs, services and employment is available to all persons. Those applicants requiring accommodation
to the application and/or interview process should contact a representative of our Human Resource Department.
Such conviction may be relevant if job-related, and may not bar you from employment.
List your last three (3) employers with the most recent listed first.
Skills and Qualifications
Educational Background (If Job Related)
I hereby certify that the information I have entered on this form is correct to the best of my knowledge. I further understand that any false, inaccurate or omitted information given to this employer as a part of the hiring process is grounds for immediate
termination no matter when such is discovered.
I give the employer the right to examine any and all criminal records, arrests, credit, and workers compensation records on file in
the counties in the State of Kansas or any other state. In doing so, I understand that I am waiving my right of confidentiality.
I give the employer the right to make a thorough investigation of my past employment activities concerning my services, character
and conduct. I release from all liability any persons, companies, and corporations supplying such information.
This employer is an Equal Opportunity Employer. Our policy is to consider all applicants for employment based on their qualifications and our current job vacancies.
This application is current for only 60 days. At the conclusion of this time, if I have not heard from the employer and still wish to be considered for employment, it will be necessary to complete a new application.
I understand that just as I am free to resign at any time, the employer reserves the right to terminate my employment at any time,
with or without cause and without prior notice. I understand that no representative of the employer has the authority to make any
assurances to the contrary.
I understand it is this company's policy not to refuse to hire a qualified individual with a disability because of this person's need for an accommodation that would be required by the ADA. I have been informed of the physical requirements for the position for
which I am applying and I can perform the physical requirements of the position.