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All applicants are considered for all positions without regard to race, color, citizenship status, religion, gender (including pregnancy), national origin, ancestry, age, physical or mental disability, domestic victim status, sexual orientation, marital status, military status, or any other characteristic protected by law, ordinance or regulation. Those applicants requiring accommodation to complete the application and/or interview process should contact Human Resources. We are an equal employment employer.

Have you ever worked for Chem-Dry of Buffalo before? YesNo

EMPLOYMENT EXPERIENCE: PLEASE LIST THE NAMES OF YOUR PRESENT OR PREVIOUS EMPLOYERS IN CHRONOLOGICAL ORDER WITH PRESENT OR MOST RECENT EMPLOYER LISTED FIRST. As NEEDED, YOU MAY INCLUDE ADDITIONAL JOBS ON A SEPARATE PIECE OF PAPER.

May we contact?YesNo

May we contact?YesNo

May we contact?YesNo

EDUCATION: PLEASE DESCRIBE YOUR EDUCATIONAL BACKGROUND IN THE TABLE PROVIDED BELOW:

High School

College/University

Graduate/Professional School

Trade School

Other

Military Service

GENERAL INFORMATION:

Days/Hours available to work:

REFERENCES (PLEASE LIST THREE REFERENCES WE MAY CONTACT REGARDING YOUR EMPLOYMENT HISTORY/CHARACTER)

APPLICANT ACKNOWLEGEMENT AND AUTHORIZATION. *PLEASE READ CAREFULLY BEFORE SUBMITTING THE APPLICATION.

- I hereby certify that all of the information provided by me in this application (or any other accompanying or required documents) is correct, accurate, and complete to the best of my knowledge. I understand that the falsification, misrepresentation or omission of any facts in said documents will be cause for denial of employment or immediate termination of employment regardless of the timing or circumstances of discovery.
- I understand that submission of an application does not guarantee an employment opportunity. I further understand that, should an offer of employment be extended by Chem-Dry of Buffalo that such employment with Chem-Dry of Buffalo is at-will, with no specified duration and may be terminated by either Chem­ Dry of Buffalo or myself at any time, with or without cause or notice. I understand that none of the documents, policies, procedures, actions, statements of Chem-Dry of Buffalo or its representatives used during the employment process is deemed a contract of employment real or implied. I understand that no representative of Chem-Dry of Buffalo except the Owner has the authority to enter into any agreement guaranteeing any conditions of employment or any agreement contrary to the foregoing statements and that any such agreements must be made in writing and signed by the Owner of Chem-Dry of Buffalo.
- I understand that if offered a position with Chem-Dry of Buffalo, I may be required to submit to a pre-employment medical examination, drug screening and background check as a condition of employment. I understand that unsatisfactory result from, refusal to cooperate with, or any attempt to affect the results of these pre-employments tests and checks will result in withdrawal of any employment offer or termination of employment if already employed.
- I hereby authorize any and all schools, former employers, references, courts, and any others who have information about me to provide such information to Chem-Dry of Buffalo and/or any of its representatives, agents or vendors.

BY CHECKING THIS BOX, I ACKNOWLEDGE THAT I HAVE READ, UNDERSTOOD, AND AGREE TO THE ABOVE STATEMENTS.