Do you currently hold a valid Kansas Drivers License with:

EMPLOYMENT RECORD (list most recent job first)

EDUCATION

Applicants must upload a current résumé to be considered.

I certify that the answers above are true and correct to the best of my knowledge. I give Max’s Breathe Easy Gases & Supplies, Inc. permission to verify this information, and release all persons, including Max’s Breathe Easy Gases & Supplies, Inc. with respect to any information provided by prior employers or personal references. I acknowledge that if any information in this application is untrue, I may be terminated. I understand that if I am employed, my continued employment is at all times subject to the policies and procedures established by Max’s Breathe Easy Gases & Supplies, Inc. with or without cause. I understand that any offer of employment to me is conditioned upon my furnishing all documents required by law to be furnished to an employer, and my ability to perform all of the essential elements of my job.