EMPLOYMENT APPLICATION

Personal Information

Education

High School - Name and Address of School

College - Name and Address of School

Graduate School - Name and Address of School

Other - Name and Address of School

U.S. Military Service

Legal

Employment History

List employment starting with your most recent position. Account for any time during this period that you were unemployed by stating the nature of your activities.

Employer

Employer

Employer

References

Business references: (do not list relatives) (please indicate if you were employed under a different name)

Please read carefully

In submitting this application for employment, I understand that an investigation may be made whereby information is obtained regarding my character, previous employment, general reputation, educational background, credit record and/or criminal history. I authorize anyone possessing this information to furnish it to La Boit, Inc. and/or a 3rd party company upon request and I release anyone so authorized, La Boit, Inc. and any 3rd party company from all liability and damages whatsoever in furnishing, obtaining or using said information.

In the event of employment, I understand that false or misleading information given in my application or interview(s) may result in immediate dismissal. I understand also, that I am required to abide by all rules and regulations of La Boit, Inc. I understand and agree that if employed, the employment will be ‘at will’. That is, either I or La Boit, Inc. may end the employment relationships at any time, for any reason, or for no reason. I understand that receipt of this application by La Boit, Inc. does not imply employment and that this application and/or any other La Boit, Inc. documents are not contracts of employment.