* Are you at least 18 Years of Age?:

Yes   No

If under 18, can you provide State-required minor work authorization?:

Yes   No

* Are you legally authorized to work in the United States?:

Yes   No

* If you are hired, will you be able to submit proof of the above?:

Yes   No

* When would you be available to begin work?:

* What are your compensation expectations for this position?:

* Type of employment desired (select all that apply):

Full-Time    Part Time    Seasonal    Temporary

* Which shift(s) are you available to work? (check all that apply):

1st    2nd    3rd

* Have you applied at Incom before?:

Yes   No

* Have you been employed at Incom in the past?:

Yes   No

If Yes, please provide details (When/Job Title):

* Are you currently employed?:

Yes   No

* If so may we contact your present employer?:

Yes   No

If presently employed, why are you considering leaving?:

Give record of all High Schools, Colleges, Universities and Vocational/Technical Schools you have attended.

School Name & Location	Did you Graduate?	Degree Received	Subjects Studied/Major
*	* Yes   No	*	*
	Yes   No
	Yes   No

Applicants MUST provide a detailed employment history below. Start with your current or most recent employer. If necessary attach a resume to add more employers and give a full employment history.

If you have not had an Employer 2 or Employer 3, you may enter N/A in the required fields.

Incomplete applications will not receive consideration.

Dates Employed	Employer Name & Address	Employer Phone
From: * To: *	* *	*
Job Title	Supervisor Name & Title	May we Contact?
*	* *	* Yes No
Responsibilities	Reason for Leaving
*	*

Dates Employed	Employer Name & Address	Employer Phone
From: * To: *	* *	*
Job Title	Supervisor Name & Title	May we Contact?
*	* *	Yes No
Responsibilities	Reason for Leaving
*	*

Dates Employed	Employer Name & Address	Employer Phone
From: * To: *	* *	*
Job Title	Supervisor Name & Title	May we Contact?
*	* *	Yes No
Responsibilities	Reason for Leaving
*	*

Name	Relationship	Phone Number	Email

If you have any questions regarding this statement, please contact our Human Resources Department before signing.

I understand that neither the completion of this application nor any other part of my consideration for employment represents an offer or contract of employment or a promise of future benefits by Incom.

Incom is an at-will employer. I understand that if I am hired, my employment with Incom is voluntarily entered into, and I will be free to resign at any time, for any reason or for no reason at all, with or without notice. Similarly, Incom may terminate the employment relationship at any time, for any reason or for no reason at all, with or without notice, consistent with applicable federal and state law.

I understand that no documents, oral statements, promises or representations regarding the terms or conditions of my employment will alter the at-will relationship or constitute a contract of employment. No such documents, statements, promises or representations may be construed to provide for a definite term of employment or in any way limit my or Incom’s right to terminate employment at will. I further understand that the at-will nature of my employment cannot be changed except by a written employment agreement signed by both the President of Incom and me. I acknowledge that no such agreement has been entered into or proposed.

I acknowledge that any offer of employment is conditional upon my passing a health evaluation, the sole purpose of which is to determine whether, with or without reasonable accommodation, I am capable of performing the essential functions of the position for which the conditional offer is made.

I further understand that any offer of employment is conditional on my passing a screening for illegal and/or unauthorized substances. Drug and Alcohol-Free Workplace Policy

I also understand that if I am hired, I will be required to establish my identity and eligibility for employment in the United States in accordance with U.S. Citizenship and Immigration Services laws and regulations.

I understand that any offer of employment is conditional on my passing a background check that may include criminal record history and information obtained from a consumer reporting agency. I understand that it will be a condition of employment or continued employment for me to authorize Incom to obtain such information, in accordance with federal and state law. I understand that such information will be evaluated on a case-by-case basis and that neither criminal history, nor adverse information on a consumer report, are necessarily bars to employment.

I certify that I am not presently bound by any oral or written agreements with any of my current or former employers that may impose limits on my conduct or that may otherwise impair my ability to perform the duties of the job that for which I am applying at Incom. Specifically, and without limitation, I certify that I am not bound by any non-disclosure, non-solicitation, non-competition, confidentiality, or proprietary information agreements with any current or former employers. I further certify that I am not subject to or otherwise aware of any other legal obligations that, if hired by Incom, would limit my ability to perform the duties of the job for which I have applied. I agree to immediately inform Incom if I subsequently enter into or become aware of any such agreement or obligation.

Note: If you are unable to make this certification, or have any questions about it, please check below. Notify Human Resources immediately and provide a copy of any agreements to which you are a party.

By signing this application I am affirming that I do not now, or at any time in the future, need sponsorship to work in the United States of America

I certify that all the information submitted by me on this application is true and complete. I understand any false information, omissions, or misrepresentations are grounds for denial of my application for employment or, if employed, for termination of employment, regardless of when any such false information, omissions, or misrepresentations are revealed or discovered.

* Please print full name as your electronic signature:

* Date: