Name and Location of School
Years Completed
Course of Study
Elementary:
5
6
7
8
High School:
1
2
3
4
College:
1
2
3
4
Vocational/Business School:
Please list all job-related organizations, clubs or activities you are/were involved in at school, except those that indicate race, religion, national origin, ancestry, sex or age.
Have you ever served in the Armed Forces?
Yes, What Branch:
No
Have you worked at this company or elsewhere under a different name, or are your educational records under a different name?
Yes, date XX/XX/XX
and name worked under:
No
Summarize any special skills and qualifications you may have acquired from other employment or experience:
Are you currently using drugs illegally?
Yes No
Have you ever been convicted of a felony?
Yes No
If Yes, please state when, where and the final outcome. A conviction record will not necessarily be a bar to employment. The factors surrounding the situation will be taken into account.
I authorize any physician or hospital to release any information to Merri -Makers or its subsidiaries should it become necessary to determine my ability to perform the duties of the job I am being considered for, or for any job I must perform in the future for Merri-Makers.
In consideration of my employment, I agree to conform to the rules and regulations of Merri-Makers. I futher understand and agree that my employment is at will, and that my employment and compensation can be terminated for any reason, with or without cause and with or without notice, at any time the option of either Merri-Makers or myself. I understand that no manager or representative of Merri-Makers, other than the CEO or President, has any authority to enter into any agreement with me for employment for any specified period of time, or to make any agreement contrary to the foregoing.