Employment Application

Personal Information

Current Address

Previous Address

Contact Information

Employment Desired

Are you available for full time employment?

Other Information

Are you 18 years or older?

Have you had previous employment at Scientific Instruments?

If the answer to either of the following two questions is yes, please provide an explanation: state the date, type of crime, place of occurrence, and the disposition. NOTE: Conviction of a crime will not necessarily disqualify you for employment. Each conviction will be judges on its own merit with respect to time and job relatedness.

Have you ever been convicted of, or plead guilty, adjudication withheld, nolle prosequi or nolo contendere to a crime?

Are you currently awaiting trial, sentencing or other disposition of a criminal charge?

Level Name Major Highest Grade Completed? (Circle) Degree/ Diploma/ GED
High School


Personal References (Do not list relatives or previous employers)

Job Applicant Acknowledgement & Authorization to Release Employment Reference Information

I understand that Scientific Instruments, Inc. (“Scientific Instruments”) will attempt to verify statements made on my application and made during my employment interview. When contacted by Scientific Instruments, I give permission for my former employers to answer any and all questions based upon information available to them in my prior employment records.

I understand that it is possible that my prior employment records may not be accurate. Nonetheless, in consideration of Scientific Instruments’ review of this application, I release Scientific Instruments and all former employers from any liability as a result of the furnishing and receiving of this reference information.

I understand that my failure to sign this reference release so that Scientific Instruments can contact references and make a full background check of my previous work history will be deemed interference with and a withdrawal of my application for employment.

I understand that Scientific Instruments requires certain information about me to evaluate my qualifications for employment and to conduct its business if I become an employee. I understand that false, incomplete or misleading statements or omissions on this application or any other pre- or post-employment form may be considered sufficient cause for dismissal, if and when discovered. The use of this application does not indicate there are positions open and does not in any way obligate Scientific Instruments.

I authorize personal references as well as developed references, other persons, companies, corporations, schools, and law enforcement agencies to furnish to Scientific Instruments and/or its agents or representatives any information they have concerning me. I understand that I have the right to make a written request within a reasonable period of time for a complete and accurate disclosure of additional information concerning the nature and scope of this investigation.

I understand that prior to obtaining any information from a credit reporting service, Scientific Instruments must first obtain my written consent in a disclosure separate from this application. I understand that Scientific Instruments shall treat all this information in a confidential manner.

I understand that if I am employed by Scientific Instruments, I must conform to the rules of Scientific Instruments. I understand that I have the right to terminate my employment at any time with or without notice, with or without cause, and that Scientific Instruments has a similar right. I understand my employment by Scientific Instruments does not constitute a guarantee that any position be continued for any length of time or that any job assignment or shift be permanent.

I understand that I may be required to work scheduled and unscheduled overtime and scheduled weekend and holiday work when required by Scientific Instruments. I understand that no one other than the President of Scientific Instruments has the authority to make any other agreement.

I understand that I may be required to submit to drug testing now or at any time in the future and I agree to such testing. I also understand that I may be required to submit to a medical evaluation. Moreover, I understand that my failure or refusal to undergo such testing will result in the withdrawal of my employment application. The Drug Free Workplace Policy Agreement & Consent Form is located on the last page of this application and must be completed.

I understand that if I am hired, confidential information regarding Scientific Instruments, and/or its customers and employees, may be available to me and that this information must not be disseminated or used except for Scientific Instruments’ benefit. If employed, I agree to keep all information about Scientific Instruments, including, such information regarding its business methods, customers and employees, confidential and shall not disclose this information to any unauthorized personnel whether within or without Scientific Instruments.

The Immigration Reform and Control Act of 1986 requires that, after employment, employers verify the legal work authorization and identity of all new employees. An offer of employment will depend upon Scientific Instruments’ ability to verify this necessary information.

Thank you for completing this application form and for your interest in employment with us. Due to the volume of applications received, we may not interview every applicant. In the event you are selected for interview, we will contact you.

Applications will not be considered active after 90 days from date of application unless renewed, in writing, by the applicant at this location.