Shift 1         Shift 2         Shift 3

Yes     No
Yes     No
Yes     No
Yes     No
Yes     No
Microsoft Word

Microsoft Excel

Microsoft Outlook


Microsoft Access

Typing (WPM)

Yes     No
Yes     No
Current Employer
Yes     No
Hour     Year
Yes     No
Hour     Year
Yes     No
Hour     Year
Male     Female

White (Not Hispanic)

Native Hawaiian/Pacific Islander

American Indian/Alaskan Native

Black/African American



Two or More Races

Not a veteran

Disabled Veteran:
A veteran who is entitled to compensation (or who but for the receipt of military retired pay would be entitled to compensation) under laws administered by the Secretary of Veterans Affairs, or A person who was discharged or released from active duty because of a service connected disability.

Other Protected Veteran:
A veteran who served on active duty during a war or in a campaign or expedition for which a campaign badge has been authorized.

Armed Forces Service Medal Veteran:
A veteran who, while serving on active duty participated in a United States military operation for which an Armed Forces service medal was awarded pursuant to Executive Order 12985.

Recently Separated Veteran:
A veteran who was discharged or released three or less years from this date

Covered Veteran:
A veteran as defined in the four categories above.

To the best of my knowledge, all information on this application is true and correct. I authorize Vermillion, Inc. to use the information given to determine my eligibility for employment, including contacting each of my former employers listed concerning my qualifications for employment. Permission is granted to each of my former employers to give Vermillion, Inc. information regarding my work experience. I understand that fraudulent statements made in this application may be cause for disqualification for employment at or dismissal from Vermillion, Inc.

Further, I understand that any offer of employment is contingent upon satisfactory results of a drug test; therefore I agree to submit to a drug test at any time deemed appropriate by Vermillion, Inc. and as permitted by law. I understand that some positions within Vermillion, Inc. may also require satisfactory results of a medical and/or vision examination and I agree to submit to such examination at any time deemed appropriate by Vermillion, Inc. and as permitted by law. I consent to allow the test providers to disclose the results from any required drug test or medical or vision examination to Vermillion, Inc.

I hereby understand and acknowledge that all employees who do not have a written, individual employment contract with a specific, fixed term of employment approved by the President are employed for an indefinite duration “at will” by Vermillion, Inc. Absent of the aforementioned agreement and in accordance with Kansas law, I or Vermillion, Inc. may terminate my employment at any time with or without notice or cause. If I am hired, I understand that a condition of my employment will be to abide by the company’s policies, rules, and regulations.

This application will remain active and in consideration for one year. Consideration for employment after one year from submission requires a new application. Thank you for your interest in Vermillion!