Fields marked with an * are required


INSTRUCTIONS: Please read carefully. Every item on this form must be answered to the best of your ability. please use a black or blue pen. Your qualifications will be carefully reviewed and you will be given thorough consideration for the position (s) for which you have applied.  Upon employment, this application will become part of your permanent record at Brinly-Hardy Company.  Keep this in mind as you complete it.

 Special Note:  You are not required to supply any information that is prohibited by Federal, State, or Local law.  We are an Equal Opportunity Employer. Brinly-Hardy Company does not discriminate on the basis of race, color, protected class. You may request assistance in completing this application.





List below all present and past employment, beginning with your most recent employer


  1. I. The facts as stated on this application are true and correct I understand that, if employed, false statements on this application may cause my immediate dismissal.
  2. II. I authorize whatever background and personal reports needed to verify that the information I have supplied is true and accurate and to determine my fitness for this job and hold harmless those who have the responsibility to develop such a report A copy of this authorization is as valid as the original.

III. I understand that I may be required to work overtime as a condition of being employed.

  1. I In consideration of my employment, I agree to conform to the rules and regulations for employees. I understand I am an employee at-will, and that this application is not a contract of employment with Brinly-Hardy Company, and that my employment and compensation can be terminated, with or without cause, at any time, at the option of either Brinly-Hardy Company, or me. I understand that no representative of Brinly-Hardy Company, has any authority to enter into any verbal agreement for employment for any specified period of time or to make any agreement contrary to the foregoing and that no document, policy or practice of Brinly-Hardy Company may change the foregoing unless it is expressly titled “Contract” and signed by the person authorized to engage in contacts for Brinly-Hardy Company.
  2. I understand that I will be required to submit to a pre-employment drug and alcohol test.
  3. VI. Upon separation of employment, I authorize Brinly-Hardy Company, to withhold from my final pay check any monies owed by me (if not prohibited by law) for equipment, loans, products, services, uniforms unreturned, benefits advanced that I have not earned, materials or other assets in my possession not promptly returned or repaid as agreed.

VII. As a condition of employment, I accept that any complaint or conflict that cannot be resolved internally may be referred to

Alternative Dispute Resolution, unless prohibited by law.