Work EMPLOYMENT APPLICATION I.M.P. AND ALL AFFILIATE COMPANIES PROVIDE EQUAL EMPLOYMENT OPPORTUNITIES (EEO) TO ALL EMPLOYEES AND APPLICANTS FOR EMPLOYMENT WITHOUT REGARD TO RACE, COLOR, RELIGION, SEX, GENDER IDENTITY, SEXUAL ORIENTATION, NATIONAL ORIGIN, AGE, DISABILITY, GENETIC INFORMATION, POLITICAL AFFILIATION, MILITARY SERVICE OR ANY OTHER CHARACTERISTIC PROTECTED BY LAW. Today's Date PERSONAL INFORMATION Name Address Phone Number Email Are you eligible to work in the US? YesNo Are you at least 18 years of age? YesNo EMPLOYMENT DESIRED Position Desired Applying for: Full TimePart TimeSeasonal Hourly Rate / Salary Desired: Date Available EMPLOYMENT HISTORY List all employment history, starting with your CURRENT OR MOST RECENT employer. Most Recent May we contact? YesNo Second Most Recent May we contact? YesNo Third Most Recent May we contact? YesNo Fourth Most Recent May we contact? YesNo Fifth Most Recent May we contact? YesNo EDUCATION List all high schools, colleges, universities and trade, business or graduate schools you have attended. School One School Two School Three School Four Do you have any special skills, experience and/or training directly related to the position for which you are applying? YesNo If yes, please describe: REFERENCES Do you know anyone who works for I.M.P. or any affiliate companies? YesNo If yes, who? List two personal references (no employers or immediate relatives) who know you and can speak to your character and integrity. Why are you interested in employment with I.M.P.? APPLICANT’S CERTIFICATION AND AGREEMENT I HEREBY CERTIFY THAT ALL INFORMATION PROVIDED ON THIS APPLICATION IS TRUE AND COMPLETE TO THE BEST OF MY ABILITY. I UNDERSTAND THAT ANY MISREPRESENTATION, DECEPTION OR FALSE STATEMENT MADE ON THIS APPLICATION MAY RESULT IN DENIAL OF EMPLOYMENT OR SUBSEQUENT DISMISSAL. I AUTHORIZE I.M.P. TO CONTACT THE PEOPLE LISTED AS REFERENCES AND PREVIOUS EMPLOYERS ON THIS APPLICATION, UNLESS OTHERWISE STATED. I UNDERSTAND THAT COMPLETION OF THIS APPLICATION DOES NOT GUARANTEE EMPLOYMENT. IF I AM HIRED, I AGREE TO FULLY ADHERE TO THE POLICIES OF I.M.P. IF I AM HIRED, I UNDERSTAND THAT MY EMPLOYMENT IS AT WILL AND THAT EITHER I.M.P. OR I CAN TERMINATE MY EMPLOYMENT AT ANY TIME FOR ANY REASON. I AGREE TO THE ABOVE STATEMENT Yes Please leave this field empty.