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Employment Application Form


Present Address



List your educational background including high school, all colleges, Trade and Military schools.

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Yes No

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Work Experience

List employment history in chronological order with present or most recent employer listed first. Account for all time including military service and any periods of unemployment. If you were self-employed, give a firm name. Attach additional sheets if necessary.

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Please read carefully!

I hereby authorize the potential employer to contact, obtain, and verify the accuracy of information contained in this application from all previous employers, educational institutions, and references. I also hereby release from liability the potential employer and its representatives for seeking, gathering, and using such information to make employment decisions and all other persons or organizations for providing such information.

I understand that any misrepresentation or material omission made by me on this application will be sufficient cause for cancellation of this application or immediate termination of employment if I am employed, whenever it may be discovered.

If I am employed, I acknowledge that there is no specified length of employment and that this application does not constitute an agreement or contract for employment. Accordingly, either I or the employer can terminate the relationship at will, with or without cause, at any time, so long as there is no violation of applicable federal or state law.

Please read carefully!

Application Form Waiver

I authorize investigation of all statements contained in this application. I understand that the misrepresentation or omission of facts called for is cause for dismissal at any time without any previous notice. I hereby give Capital Industries permission to contact schools, previous employers (unless otherwise indicated), references, and others, and hereby release Capital Industries from any liability as a result of such contact.

I also understand that (1) Capital Industries has a drug and alcohol policy that provides for pre-employment testing as well as testing after employment; (2) consent to and compliance with such policy is a condition of my employment, and (3) continued employment is based on the successful passing of testing under such policy. I further understand that continued employment may be based on the successful passing of job-related physical examinations.

I understand that, in connection with the routine processing of my employment application, Capital Industries may request from a consumer reporting agency an investigative consumer report including information as to my credit records, criminal record, character, general reputation, personal characteristics, mode of living, and driving record. Upon written request from me, Capital Industries will provide me with additional information concerning the nature and scope of any such report requested by it, as required by the Fair Credit Reporting Act.

Capital Industries is an equal employment opportunity employer. We adhere to a policy of making employment decisions without regard to race, color, religion, sex, sexual orientation, national origin, veteran status, genetic information, age or physical/mental disability. We assure you that your opportunity for employment with Capital Industries depends solely on your qualifications.

Thank you for completing this application form and for your interest in Capital Industries.


Please list three professional references not related to you with full name, address, and phone number.

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