Application for EmploymentName *Address *Street AddressApt, Suite, Bldg. (optional)CityState / Province / RegionPostal / Zip CodeAfghanistanAlbaniaAlgeriaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCentral African RepublicChadChileChinaColombiaComorosCongo (Brazzaville)CongoCosta RicaCote d\'IvoireCroatiaCubaCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast Timor (Timor Timur)EcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFijiFinlandFranceGabonGambia, TheGeorgiaGermanyGhanaGreeceGrenadaGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiKorea, NorthKorea, SouthKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorwayOmanPakistanPalestinian TerritoryPalauPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint VincentSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSudanSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited States of AmericaUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamWestern SaharaWestern SamoaYemenZambiaZimbabweCountryHome Phone *Cell Phone *Driver's License Number *Are you at least 18 years of age? *YesNoEmail *Can you legally work in the U.S.? *YesNoWhich position(s) do you seek? *Are you seeking a full-time position? *YesNoWhat rate of pay do you require? *Are you willing to work overtime, holidays, or weekends, as needed? *Reasonable accommodations can be made in appropriate circumstancesYesNoHave you ever been convicted of a crime? *YesNoIf yes, provide details, including date(s), jurisdiction, and what crime: A record of conviction does not necessarily exclude employment. Factors such as whether the conviction is related to the job being sought, the seriousness of the crime and how long ago the conviction occurred will be considered.Has your driver’s license ever been revoked or suspended? *YesNoIf yes, when, why? Not applicable, unless position requires vehicular business travel.What professional licenses do you hold that relate to the job you seek? *What specialized education, skills, or training do you possess that relate to the job you seek? *EducationHigh School Name & Location *High School Major Subject *High School Years Completed *Diploma or Certificate *University or College *University / College Major or Subject *University / College Number of Years *University / College Degree *Other Military Service, Trade, Business, Graduate SchoolWork Experience #1Name and Address of Employer *Dates Employed *Starting month and year to end year.Position Held *Duties *Supervisor's Name *Salary Received *Reason for Separation *Work Experience #2Name and Address of Employer *Dates Employed *Starting month and year to end year.Position Held *Duties *Supervisor's Name *Salary Received *Reason for Separation *Work Experience #3Name & Address of Employer *Dates Employed *Starting month and year to end year.Position Held *Duties *Supervisor's Name *Salary Received *Reason for Separation *ReferencesList at least three (3) business references. *Name of Reference, Address, Telephone, and RelationshipNarrative *Write a summary of the reasons you have sought employment with us and what qualifies you for this positionAUTHORIZATIONS AND ACKNOWLEDGMENTS I certify that the information contained in this application (and resume, if applicable) is true and complete. I understand that falsification or omission of relevant facts in my application, resume, other materials provided during my interview, or during my employment, if hired, is grounds for disqualification from further consideration or for discipline or dismissal from employment. I agree to conform to the rules and regulations of LIQUID CALCIUM CHLORIDE SALES, INC., and understand that my employment relationship with LIQUID CALCIUM CHLORIDE SALES, INC. is “at-will” and that I or LIQUID CALCIUM CHLORIDE SALES, INC. may terminate my employment with or without cause, and with or without advance notice, at any time. I further understand that no LIQUID CALCIUM CHLORIDE SALES, INC. agent or representative has any authority to enter into a contract of employment with me or my duly authorized agent/representative except for the Operations Manager. I acknowledge that any such agreement must be in writing and signed by the Operations Manager. I agree that I will comply with all policies, procedures and work rules of LIQUID CALCIUM CHLORIDE SALES, INC., whether verbal or written. I acknowledge that any offer of employment I may receive from LIQUID CALCIUM CHLORIDE SALES, INC. is contingent on the results of an investigative consumer report (reference and background check). Therefore, I authorize LIQUID CALCIUM CHLORIDE SALES, INC. to: (1) investigate the truthfulness of all statements made on this application, or my resume; (2) contact my current or former employers and other listed references or any other persons who can verify information (including law enforcement agencies); and (3) discuss results of any investigation with other persons involved in the hiring process. In addition, I give my consent for all contacted persons, including former employers, to provide information concerning this application, and I release each such person from liability for providing information. I waive any written notice for the release of such information which may be required under state or federal law. I hereby give my consent for LIQUID CALCIUM CHLORIDE SALES, INC., through an authorized agent, to collect my urine, saliva, blood, or hair sample(s) for the purposes of testing for the presence, and my use of, alcohol, drugs, or other controlled substances. I hereby release LIQUID CALCIUM CHLORIDE SALES, INC. and its authorized collection/testing agent from any liability whatsoever, including attorneys’ fees, from any liability resulting from the collection or testing process or from the test’s results. I further understand that should I receive an offer of employment, it may be conditioned upon my undergoing and successfully passing a job-related medical examination. I also understand and agree that, if employed, I may be required to submit to an alcohol or drug test, or medical examination at any time as it pertains to my job and/or the need for accommodation. I hereby consent to having the results of any such alcohol or drug test or medical examination disclosed to LIQUID CALCIUM CHLORIDE SALES, INC. I also acknowledge that any offer of employment that I receive is contingent upon the results of my medical examination, if applicable, finding me able to perform the essential functions of the job offered with or without reasonable accommodation. I understand that a positive drug test result, a refusal to submit a requested sample for testing, or a refusal to authorize such testing may result in LIQUID CALCIUM CHLORIDE SALES, INC. withdrawing any offer of employment made to me, or result in my immediate discipline or dismissal. Should I have a legally protected physical or mental disability that affects my ability to perform the job that I seek, I understand that I may request that LIQUID CALCIUM CHLORIDE SALES, INC. provide a reasonable accommodation for it. I am aware that I must make any such request for accommodation immediately known and no later than 182 days after the date that I know, or reasonably should have known, of my need for an accommodation under state law and that federal law has no similar time limitation.I HAVE READ AND UNDERSTAND THE ABOVE AUTHORIZATION AND ACKNOWLEDGEMENTS AND ACCEPT THEM IN THEIR ENTIRETY. I CERTIFY THAT THE INFORMATION I HAVE PROVIDED IS TRUE AND ACCURATE. Applicant's Name *Today's Date *KNOWING AND VOLUNTARY LITIGATION AGREEMENT AND WAIVER OF JURY TRIAL LIQUID CALCIUM CHLORIDE SALES, INC., and all of its parent organizations and affiliates, (“Employer” or “LIQUID CALCIUM CHLORIDE SALES, INC.”), and _____________________________ (“Employee” or “Applicant”), as a condition of initial and continued employment, future promotions, compensation increases, use of LIQUID CALCIUM CHLORIDE SALES, INC.’s property, facilities, materials, resources, access to LIQUID CALCIUM CHLORIDE SALES, INC.’s trade secrets and/or confidential information, access to LIQUID CALCIUM CHLORIDE SALES, INC.’ customers, and other additional benefits that the parties agree are valuable considerations for signing this Knowing and Voluntary Litigation Agreement and Waiver of Jury Trial (“Agreement”), agree to litigate any claims involving the Employee’s employment or termination of employment according to the following terms:1. THE PARTIES UNDERSTAND AND AGREE THAT THIS AGREEMENT WAIVES THEIR RIGHT TO A JURY TRIAL, IF APPLICABLE, AND INSTEAD ALLOWS ONLY FOR A BENCH TRIAL BEFORE A JUDGE WITHOUT A JURY. 2. The parties understand and agree that any charge, claim or lawsuit relating to Employee’s employment, Applicant’s application for employment with Employer, and/or concerning any agent of Employer (except those that the law specifically excludes from shortening the statutes of limitations) must be filed no later than one hundred and eighty (180) calendar days from the date the alleged employment action arose, or less if the applicable statute of limitations period is shorter for the specific cause of action. The parties agree to waive any statute of limitations or other time period to make a claim to the contrary. The parties further understand and agree that any lawsuit must be filed in a court of competent jurisdiction in Bay County, Michigan or in the United States District Court for the Eastern District of Michigan, Northern Division. If a party fails to file their charge, claim or lawsuit within one hundred and eighty (180) calendar days from the date the alleged claim arose, or less if the applicable statute of limitations period is shorter for the specific cause of action, they will forever lose their right to litigate their claim in any manner. If a party loses their right to litigate their claim under this agreement, they cannot file suit or a claim in any other jurisdiction or forum. Should either party file their claim in a court or forum not pursuant to this agreement, the action shall not toll or extend the time for filing pursuant to this Agreement. The parties agree that any dispute about the timeliness of any such claim, charge, or lawsuit shall be determined by the Bay County Circuit Court or United States District Court for the Eastern District of Michigan, Northern Division, and not by any arbitrator or other person. 3. The parties shall have all other rights pursuant to applicable court rules at each party’s own expense. 4. The Employee acknowledges that he/she is an employee at-will, unless subject to a collective bargaining agreement or other written just cause employment contract. Nothing in this Agreement creates an expressed or implied employment contract. The Employee understands that only an employment agreement that the Employer’s Operations Manager signs specifically changing the at-will employment relationship is valid to make such a change. 5. This Agreement, together with the Employee’s Application for Employment, and any applicable written Employment Agreement identified above, and any signed Restrictive Covenants Agreement, all incorporated by reference, constitute the complete Agreement between the parties on the litigation of disputes. This Agreement shall govern the litigation of disputes for all of the above Agreements. This Agreement supersedes any prior oral or written understanding on the subject. Neither party is relying on any oral, nor written, representations of any type other than those contained in this Agreement for the litigation of disputes. If any judge determines that any partial or complete provision of this Agreement is invalid, or otherwise unenforceable, the invalid or unenforceable provision shall be stricken, or revised in whole or in part to reflect the intent of the parties at the time of signing. 6. The Employee or Applicant has been advised and has had the opportunity to consult an attorney for review and explanation of this Agreement, at his/her expense, prior to signing it. Receipt of this Agreement acknowledges that each party is responsible for carefully reading it and understanding that it contains a binding election to waive a jury trial, reduces the filing period to 180 calendar days or less, and elects Bay County as the venue for litigation or the applicable federal court. The parties have entered into this Agreement voluntarily as a condition of employment, and/or continued employment, including future promotions, pay increases, use of any LIQUID CALCIUM CHLORIDE SALES, INC. equipment, materials or resources, and/or access to customers and customer information. The parties further acknowledge that the actions of the Employee engaging in, or continuing employment, using LIQUID CALCIUM CHLORIDE SALES, INC.’s property and facilities, accepting compensation and benefits, continuing contact with LIQUID CALCIUM CHLORIDE SALES, INC. members, and continuing to have access to and use of LIQUID CALCIUM CHLORIDE SALES, INC.’ trade secrets and/or confidential information constitutes each party’s mutual assent to be bound by this Agreement whether or not fully executed by both parties.Employee Name *LIQUID CALCIUM CHLORIDE SALES, INC.: Date Date * VerificationPlease enter any two digits *Example: 12This box is for spam protection - please leave it blank:
