Our company (“Company”) fully subscribes to the principles of Equal Employment Opportunity. It is our
policy to provide employment, compensation, and other benefits related to employment based on
qualifications, without regard to race, color, religion, national origin, age, sex, veteran status, genetic
information, disability, or any other basis prohibited by federal, state or local law. In accordance with
requirements of the Americans with Disabilities Act and applicable federal, state and/or local laws, it is our
policy to provide reasonable accommodation upon request during the application process to applicants in
order that they may be given a full and fair opportunity to be considered for employment. As an Equal
Opportunity Employer, we intend to comply fully with applicable federal, state and/or local employment laws
and the information requested on this application will only be used for purposes consistent with those laws.
To the extent required by applicable law, The Company maintains a smoke- free workplace.
Applicants for positions in Rhode Island please note that the Company and ADP TotalSource, our
Professional Employer Organization are subject to Chapters 29-38 of Title 28 of the General Laws of Rhode
Island and are therefore covered by the state's workers compensation law.
* Note: It is not necessary for you to identify unavailability for work because
of religious observance or practice or any other protected classification. Subsequent to any job offer, we will consider whether a
reasonable accommodation can be made.
Note: The Federal Immigration and Reform and Control Act of 1986 requires that a DHS Employment Eligibility
Verification “Form I-9” be completed for every new hire and that within 3 business days of beginning work every new
hire must present to the employer documentation establishing his/her identity and authorization to work. This federal
requirement must be satisfied as a condition of employment.
Answer only if driving is a requirment for the job for you which you are applying.
Describe any educational degrees, skills, training or experience you believe are relevant to the job applied for:
Please complete for all full-time or part-time employment beginning with most recent employer. You may
include as part of your employment history any verified work performed on a volunteer basis. All applicants
should start with their most recent job, include military assignments and voluntary employment and provide ten
(10) years of history. You must explain any gaps in your employment history (a separate area will be provided
at the end of the section).
Please list three individuals unrelated to you with whom you have worked who know your qualifications for this position.
Complete only if you served in the miltary
Massachusetts Applicants Note: 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.
Maryland Applicants Note: An employer may not require or demand, as a condition or prospective
employment or continued employment, an individual submit to or take a lie detector or similar test. An
employer who violates this law is guilty of a misdemeanor and subject to a fine not exceeding $100. I
have read and acknowledge this notice:
By placing your initials in the box below, you are stating that you have read the above paragraphs.
I certify that the answers given herein and during the entire application process (including but not limited
to any criminal record inquiries made following this application, resumes, attachments to this application,
interviews or otherwise (if applicable)) are true and complete to the best of my knowledge.
I understand that any misrepresentations, omissions of facts or incomplete answers during the application
process may disqualify me from further consideration for employment. I further understand that, if
employed, any misrepresentations or omissions of facts during the application process may be cause for
my dismissal at any time without prior notice.
I consent to and authorize the Company and ADP TotalSource® to contact my
former employers, references, and any and all other persons and organizations
for information bearing upon my qualifications for employment.
I further authorize the listed employers, schools and personal references to give
the Company or ADP TotalSource (without further notice to me) any and all
information about my previous employment and education, along with any other
pertinent information they may have and hereby waive any actions which I may
have against either party(ies) for providing a good faith reference.
I EXPRESSLY AGREE AND UNDERSTAND THAT, IF EMPLOYED, MY EMPLOYMENT IS NOT FOR A
SPECIFIC TERM, IS BASED ON MUTUAL CONSENT AND MAY BE TERMINATED BY ME OR THE
COMPANY OR ADP TOTALSOURCE WITH OR WITHOUT NOTICE OR CAUSE AT ANY TIME. I
FURTHER UNDERSTAND THAT NO ORAL PROMISE, EMPLOYER POLICY, CUSTOM, BUSINESS
PRACTICE OR OTHER PROCEDURE (INCLUDING THE BASIC EMPLOYMENT POLICIES, PERSONNEL
HANDBOOK OR ANY PERSONNEL MANUALS) CONSTITUTES AN EMPLOYMENT CONTRACT OR
MODIFICATION OF THE AT-WILL EMPLOYMENT RELATIONSHIP BETWEEN ME AND THE COMPANY
OR ADP TOTALSOURCE.
I ALSO UNDERSTAND THAT MY AT-WILL EMPLOYMENT STATUS WITH THE COMPANY MAY ONLY
BE ALTERED IN AN INDIVIDUAL CASE OR GENERALLY IN A WRITING SIGNED BY THE OWNER,
PRESIDENT OR CEO OF THE COMPANY AND THAT MY AT-WILL STATUS WITH ADP
TOTALSOURCE MAY ONLY BE ALTERED IN AN INDIVIDUAL CASE OR GENERALLY IN A WRITING
SIGNED BY THE PRESIDENT OF ADP TOTALSOURCE.
I understand that I may be required to qualify for employment based on additional employment criteria.
For example, I may be required to take job-related tests; take a driver’s examination; submit to a
background investigation or take a pre-employment drug test. If I am offered employment or start work
before any required test is completed, I understand that my employment is contingent on a satisfactory
result on all required tests. I authorize the Company and ADP TotalSource to release the results of
background checks (if any) and my pre-employment drug/alcohol test (if any), any information on this
application and any relevant information about me to each other and to other ADP TotalSource clients for
whom I have applied for employment, and release the Company, ADP TotalSource and its clients from
any and all claims related to the lawful release of this information. I further authorize the release of any
background check results and of any drug/alcohol test to any state or federal authority requesting such
information and in response to a valid subpoena or other legal document. I agree to sign any additional
forms necessary for pre-employment checks and/or tests to be conducted.
CALIFORNIA APPLICANTS ONLY: I understand the Company or ADP TotalSource may obtain, without
using the services of a third party investigative consumer reporting agency, public records pertaining to
my character, general reputation, personal characteristics or mode of living during its evaluation of my
application for employment and, if employed, during my employment. By checking the following box, I
waive my right to receive copies of public records obtained by the Company or ADP TotalSource.
By entering your name in the field below, you are signing this application in complete and you have entered everything truthfully.
By pressing submit below you are acknowledging that you have read, understand, and confirm the Applicant's Statement as written above.