Application For Employment

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Job Position Applied For:
First Name:
Last Name :
Social Security Number :
Street Address:
Address (cont.):
City:
State/Province:
Zip/Postal Code:
Email:
Phone:	- -  ext.

How would you prefer to be contacted?	Email    Phone
If you are under 18 years of age, can you provide required proof of your eligibility to work?	Yes      No
Have you filled out an application before?	Yes      No

Are you currently employed?	Yes      No
May we contact your present employer?	Yes      No
Are you prevented from lawfully becoming employed in this country because of Visa or Immigration Status?	Yes      No

Are you related to any current Miller Company employee?	Yes      No
If required for position, do you have a valid driver's license?	Yes      No

If you answered Yes to any question above, please give details.

How did you learn about this employment opportunity?

Website

Ad in newspaper

Referral by employee

other

Education

High School

GED

College

Other

Give the years and dates attended and if you graduated. What was your major?

Give credentials/ Licenses/ professional affiliations, etc., which are relevant to the job, below.

SKILLS: Please list technical skills, clerical skills, trade skills, etc., relevant to this position. Include relevant computer systems and sofware packages of which you have a knowledge, and note your level of proficiency (basic, intermediate, expert)

WORK EXPERIENCE: Please detail your entire work history. Begin with your current or most recentemployer. If you held multiple positions with the same oraganization, detail each position separately. Omission of prior employment may be considered falsification of information. Please explain any gaps in employment. Include full-time or volunteer commitments. The Miller Company reserves the right to contact all current and former employers for reference information.

PLEASE READ CAREFULLY AND SUMBIT IF YOU AGREE AND ACCEPT THIS INFORMATION .

I certify that the information on this application and its supporting documents is accurate and complete. I understand and agree that failure to fully complete the form, or misrepresentation or omission of facts, represents grounds for elimination from consideration for employment, or termination after employment if discovered at a later date. I authorize { The Miller Company} to investigate, without liability, all statements contained in this application and supporting materials. I authorize references and former employers, without liability, to make full response to any inquiries in connection with this application for employment. If requested, I agree to submit to a physical exam, criminal and credit background investigation, and/or screening for illegal substances upon conditional offer of employment. I understand that this document is NOT an offer of employment, and that an offer of employment, if tendered, does NOT constitute a contract for continued guaranteed employment. I understand that staff employees of {The Miller Conpany} serve at-will, and the employment relationship may be terminated at any time by either party, or any or no reason, other than a reason prohibited by law. If employed, I will be required to furnish proof of eligibility to work in the United States , to file a State security questionnaire and State loyalty oath, and to comply with company and departmental regulations. I understand that if employed on a temporary basis, I would be paid for hours worked only, and would be ineligible for benefits including paid time off. If employed on a regular, benefits-eligible basis, I understand that I would be required to make mandatory contributions to the {The Miller Company} Retirement System or to an optional retirement program, if applicable. I understand that any benefits I receive may be subject to change or discontinuation at any time without prior notice. I understand that the first SIX MONTHS of regular employment represent a provisional period, during which I would not be eligible to apply for transfer or promotion and during which I may be terminated without right of appeal.