Employment Application

PERSONAL INFORMATION


EMPLOYMENT RELATED

Are you legally authorized to work in the United States? *
Are you below the age of 18? *
Have you previously applied for employment here? *
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Have you previously been employed by this company or its subsidiaries? *
Do you wish to work: *
What is your minimum compensation required? (select one)
Type *

Are you aware of any circumstances which would restrict or prevent your employment with Butech (such as a non-compete or confidentiality agreement)? *
0/8000 characters
0/8000 characters
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EDUCATIONAL DATA

High School


College


Graduate School


Trade, Business, or Night School


Other


EMPLOYMENT HISTORY

List present employer or most recent employer first. May we contact these employers?

Employer 1

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Employer 2

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0/8000 characters

Employer 3

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0/8000 characters

Employer 4

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0/8000 characters

GENERAL INFORMATION

0/8000 characters
Do you know of any reason why you cannot perform the essential functions of the job for which you are applying with or without reasonable accommodation? *

Have you been convicted of a criminal offense?
(An affirmative answer will not automatically disqualify you from being considered for employment.) *
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MILITARY EXPERIENCE

Were you in U.S. Armed Forces? *
If you were in the U.S. Armed Forces please provide the following information:
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0/8000 characters

REFERENCES

(Not employers or relatives--------at least three)

Reference 1


Reference 2


Reference 3


Reference 4


IMPORTANT NOTICE

Any offer received as a result of your submission of an application to Butech Bliss is conditioned upon
satisfactory completion of any physical examination required by Butech Bliss. If you are a successful applicant,
you will be notified of any physical examination requirements after an offer of employment is made.

Butech Bliss has made a commitment to maintain a work environment free from alcohol and drug abuse. A
substance screening test may be required as a part of any post-offer physical examination requirement, or may be required by itself. Failure to pass the substance screen test, or refusal to submit to it, will result in automatic revocation of any offer of employment.

The following consent form must be signed for further processing of your application, and will remain a
part of your permanent materials.

APPLICANT CONSENT

I understand and agree that I may be required to take and pass a physical examination and/or substance
screen test as a condition of my employment with Butech Bliss.

I understand that if I decline to sign this consent and decline to take the test or tests, the examination will
not be completed. Butech Bliss will be notified and my application for employment will be rejected or my
employment will be terminated. I understand that the test results and other medical information will be released only to authorized company personnel or testing facility personnel for appropriate consideration.
 
I hereby voluntarily consent to allow Butech Bliss, or its agents, to collect urine specimens from me for
testing for alcohol, drugs, and controlled substances. Further, I give my consent for the release of the test results to the appropriate members of the company’s management, or their appropriate agents. I understand that any positive results will preclude my employment.

AGREEMENT

(Please read the following statement carefully)
By placing my initials here, I hereby affirm that the information provided on this application (and accompanying resume, if any) is true and complete to the best of my knowledge. I also agree that falsified information or significant omissions may disqualify me from further consideration for employment and may be considered justification for dismissal if discovered at a later date.
 
I understand that my employment can be terminated, with or without cause, at any time at the discretion of either the company or myself. I understand that no management official other than the president of the company has any authority to enter into any agreement contrary to the foregoing or make any oral assurance or promise of continued employment.
 
I authorize persons, schools, my current employer (if applicable), and previous employers and organizations named in this application (and any accompanying resume, if any) to provide any relevant information that may be required to arrive at an employment decision.

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