Application for Employment

Personal Information


Employment Desired

Former Employment

List below your last four employers, starting with the last one first.


Name of School

Name of School

Name of School


Give the names of three persons not related to you whom you have known at least one year.

Terms of Employment

Read carefully and sign below if you agree to these Terms of Employment

I, the undersigned applicant for employment, certify that the facts contained in this application are true and complete. I authorize and request my former employers, references, and educational institutions, and any credit agencies or reporting services which have information about me, to give Lorin Industries, Inc. (the "Company") any and all information and opinions about me in their possession; I hereby waive written notice of such release of information and opinions, and I release such former employers, references, educational institutions and credit agencies or reporting services from any liability or claim
relating to such release of information and opinions. I also authorize and request federal, state, and local governmental agencies to release to the Company any information requested concerning any criminal convictions on my records.

I understand and agree that all employment at the Company is on an at-will basis, and may be terminated by me or the Company at any time with or without notice and with or without cause. I understand and agree that no one employed by the Company (except the Company’s President by a specific written contract for a specific term of years naming me and signed by me and the President) has any authority to offer employment other than on an at-will basis. I also understand and agree to the Company’s policy that the Company’s decisions on all employment related matters are final, and are not subject to review or appeal outside the Company except as required by laws providing or requiring employers to provide specific employment standards and rights. I understand and agree that all benefits, programs, rules and policies of the Company are subject to exceptions or change at any time as decided by the Company.

I agree that any action, suit or claim (together, "Claim") against the Company, its directors, officers, employees or agents arising out of my employment or termination of the employment, including buy not limited to, any Claim arising under State and Federal civil rights statutes must be brought, if at all, within 180 days of the events given rise to the Claim (or within the time frame provided by any shorter statute of limitations), or they will be forever barred. I understand that this means that even if the law would give me the right, and that any Claim not brought within 180 days of the event giving rise to the Claim after my employment ends will be barred. I waive any statute of limitations to the contrary. I also agree that in the event I file any Claim against the Company, its directors, officers, employees or agents and notwithstanding any rights to a jury trial for any Claim, I waive any such rights, and agree that any Claim of any type lodged in any court will be tried - if at all - without a jury.

By dating and entering your name, you agree to the above Terms of Employment.


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