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Personal Information
First Name
Last Name
ZIP Code
Daytime Phone

Position applying for


Work Availability


Available Work Times


Were you referred by a
Dixon employee?

If yes, enter employee's name:

Have you ever been
employed by Dixon?

If yes, when:

Have you ever been
convicted of a crime?

If yes, please explain:

Are you an US citizen?   
Are you legally eligible to
work in the U.S.?
Have you lived in NC for
at least 5 years?
Are you currently a student?   

Highest Level          Graduate School
Please list any
certificates and licenses.

Employment History
Job 1
Business Name  Title  Phone
Description of duties?
Reason for leaving?
Job 2
Business Name  Title  Phone
Description of duties?
Reason for leaving?
Job 3
Business Name  Title  Phone
Description of duties?
Reason for leaving?

Are you proficient
on a computer?
Do you use email
and the internet?
Please list any software
programs you have used.
Do you type?

If yes, how many wpm?

I, the applicant, certify that the information provided on this application is true, complete and correct to the best of my knowledge. I authorize investigation of all statements contained in this application for contract of services as may be necessary in arriving at an employment decision. In the event of contract of services, I understand that false or misleading information given in my application or interview(s) may result in discharge. I understand, also, that I am required to abide by all rules and regulations of DIXON.

I authorize DIXON to conduct and obtain a State and National criminal record check using the information that I have provided in this application. I understand that my employment is contingent upon the results of the criminal record check. The fact of conviction of a criminal offense alone shall not be a bar to employment; however, certain factors shall be considered by DIXON. If the DIXON disqualifies an applicant after consideration of the relevant factors, then DIXON may disclose information contained in the criminal history record check that is relevant to the disqualification, but may not provide a copy of the criminal history record check to the applicant.

By submitting this application, I hereby acknowledge that I have read and agree to the above statements.




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