* = Required fields

Have you ever been convicted of a felony, or a misdemeanor involving any violent act, use or possession of a weapon, or act of dishonesty for which the record has not been sealed or expunged, or do you have such a case pending?

If under 18 years of age, you will be required to submit a birth certificate or work certificate as required by California or federal law.

Education Information

Your Availability For Work

  From: To:
Give Three References That Are Not Former Employers Who We May Contact
Name and Occupation: How do you know them, and for how long? Phone Number:

Your Employment History

Employment History #1

Dates of Employment:
Hourly pay or salary:
Employment History #2

Dates of Employment:
Hourly pay or salary:
Employment History #3

Dates of Employment:
Hourly pay or salary:

Have you had any vehicle accidents in the past 3 years in which you were at fault? *

Have you had any moving violations (speeding tickets, etc.) during the past 3 years?*

Additional Information


I certifY that all of the information provided in this employment application are true and complete to the best of my knowledge, and I authorize investigation of all statements contained in this application, including a criminal background and credit history check I understand that any false or incomplete information may disqualifY me from further consideration for employment and may result in my immediate discharge if discovered at a later date.

I understand and acknowledge that unless otherwise defined by applicable law or written agreement with C.A. Newcomb & Sons, any employment relationship with C.A. Newcomb & Sons is considered "employment at will." This means the Employee may resign at any time and the Employer may discharge the Employee at any time, with or without cause, and with or without advance notice.

I authorize the investigation of any or all statements contained in this application and also authorize any person, school, current employer, past employers, and other organizations to provide information concerning my previous employment and other relevant information that may be useful in making a hiring decision. I release such persons and organizations from any legal liability in making such statements.