Employment Application
How did you hear about us?

Are you prevented from lawfully becoming employed in this country because of Visa or Immigration Status?

Proof of citizenship or immigration status will be required upon employment.

Have you been convicted of a crime? 

If 'yes' please provide dates and what you were convicted of

Do you have a valid drivers license?

Do you have a reliable vehicle to get from destination to destination?

Employment Experience

Please start with your most current job 


List any certifications/licenses you have obtained:


Please list at least three (3) individuals who are qualified to describe your abilities. Previous employers, clergy, teachers, fellow workers, etc. (Do not use personal friends or relatives).

Reference 1:

Reference 2:

Reference 3:

Applicant’s Statement
I hereby authorize this company, and also authorize and request each former employer or person, firm or corporation given above as a reference, to answer all questions that may be asked regarding the information I have provided on this application for employment or concerning my work habits, character or skills.


I certify that answers given herein are true and complete to the best of my knowledge.
I authorize investigation of all statements contained in this application for employment as may be necessary in arriving at an employment decision.


I hereby understand and acknowledge that, unless otherwise defined by applicable law, any employment relationship with this organization is of an “at will” nature, which means that the employee may resign at any time and the employer may discharge employee at any time with or without cause. It is further understood that this “at will” employment relationship may not be changed by any written document or by contract unless such change is specifically acknowledged in writing by an authorized executive of this organization.

In the event of employment, I understand that false or misleading information given in my application or interview(s) may result in dis-charge.

I understand, also, that I am required to abide by all rules and regulations of the employer.

Your Signature

Administrative Office

25 Church Street

Saranac Lake, NY 12983



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