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2599 Route 112 Medford, NY 11763

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Job Application

Please complete this form in one session. You will need information about education, past employment,  & references

Position You Are Interested In
Referral Source
Are you legally eligible for employment in this country?

If you are under 18, and it is required, can you furnish a work permit?

If no, please explain:

You may upload your resume here or alternatively answer the following questions:

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Educational Background- List the last 3 schools, listing the most recent first.

Employment History- Provide the following information for your current and past employers, assignments or volunteer activities, beginning with the most recent.

References- List 3 business /work references that are not related to you. If not applicable, list 3 school or personal references that are not related to you.

Additional Comments- If there is anything else you would like share with us you may do so here. (optional)

I understand and agree that:

  • The information that I have provided on this application is true and complete to the best of my knowledge. Any misrepresentation or omission of any fact in my application, resume or any other materials or during my interview can be justification for refusal of employment or if employed, termination from the company.

  • I give the employer the right to contact and obtain  information from all references, employers and educational institutions, and otherwise verify the accuracy of the information contained in this application. I hereby release from liability the employer and its representatives for seeking, gathering and using such information, and all other persons, corporations or organizations for furnishing such information.

  • If I am hired, I understand that I am free to resign at any time with or without cause and without prior notice, and the company reserves the same rights to terminate my employment at any time, with or without cause and without prior notice, except as may be required by law.

  • This application does not constitute an agreement for contract of employment for any specified period or definite duration.  I understand that no representative of the employer other than an authorized officer has the authority to make any assurance to the contrary/ I further understand that any such assurances must be in writing and signed by an authorized officer.

  • 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 for me to fill out a new application.

  • I understand that this company's policy not to refuse to hire a qualified individual with a disability because of the person's need for a reasonable accommodation, unless doing so is an undue hardship for the company.