THE HOLLAND INC./BURGERVILLE MANAGEMENT EMPLOYMENT APPLICATION

An Equal Opportunity Employer

We do not discriminate on the basis of race, religion, color, national origin, ancestry, sex, sexual orientation, age, physical or mental disability, marital status, gender identity, workers compensation or veteran status or any other reason prohibited by applicable nondiscrimination law. It is our intention that all applicants be given equal opportunity and that selection decisions are based on job related factors. Any person needing reasonable accommodation in the application process should contact Human Resources.

General Information

Work Experience

List your last 10 years of employment with the most recent first; explain any periods of unemployment.

Employer and Location Supervisor's Name/Contact information From - To Title and Responsibilities Salary - Start/Finish Reason for Leaving

Professional Work Related References

Name Contact Information

Education

School City, State Major Course of Study - Diploma/Degrees Received GPA

Job related skills & qualifications

Special Training Dates Content

By submitting this form you agree...

I certify that the answers given by me to the foregoing questions and the information provided during the application process are complete, true and correct without material omissions, and I understand that omissions and/or false statements on this application or during the application process may result in denial of employment or dismissal if hired.

I authorize investigation of all information provided during the application process and any references to give you any and all information concerning my previous employment and any pertinent information they may have, personal or otherwise, and release from all liability or responsibility this Company, its agents and all persons, companies or corporations providing information to the Company about me.

I understand that my relationship with the company is at will and for an unspecified term and the company and I each have the right to terminate the employment relationship at any time with or without cause. This at-will employment relationship may not be modified by any oral or implied agreement or by a person, statement, act, series of events or pattern of conduct. I understand that any job offer that may be extended to me may be contingent upon the successful completion of a drug test and background check. I have had an opportunity to have my questions about this statement's content and intent answered and understand its terms.