Personal Information

Name*
Date of Birth*

Contact Information

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Pre-Employment Questionaire

Are you prevented from lawfully becoming employed in this country because of visa or immigration status?*
Do you have a good driving record?*
Have you ever been charged or convicted of a felony?*
Date of conviction
Are you willing to take a pre-employment drug screen?*
Have you had a DUI within the last five years?*
For driving positions - Upload photo of license.
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Employment Desired

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Date you can start

Employment Status

Are you currently employed?
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Resume

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Former Employers

Most Recent or Current Employer

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SECOND EMPLOYER

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THIRD EMPLOYER

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FOURTH EMPLOYER

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Pre-Employment Application, Authorization, Release and Declaration

NOTICE:

At the time of the application, you are required to prove your identity by photo ID and when necessary, proof of your ability to accept a job in the United States and produce any documents issued by the INS.


I certify the facts contained in this application and any accompanying resume are true and complete to the best of my knowledge. I understand any false statement, omission, or misrepresentation on this application is sufficient cause for refusal to hire or dismissal if I have been hired, regardless of when any inconsistencies are discovered by the company.


I understand any employment is conditioned upon a background check. I authorize this company to thoroughly investigate all statements contained in my application or resume, and I authorize my former employers and my references to disclose information regarding my former employment, character and my general reputation to the company or their investigative agents without giving me prior notice to such disclosure. I release and hold harmless the company, their background investigators, my former employers and all references listed above from any and all claims, demands or liabilities arising out of or related to such investigation or disclosures.


FAIR CREDIT REPORTING ACT:

I understand a consumer report may be ordered for employment screening purposes. I hereby give my permission for such a report to be procured. I understand I am entitled to see a copy of this report and a copy of “Summary of Consumer Rights” before any adverse action is taken by this employer. I understand the information in this report will not be used in violation of any State or Federal Equal Opportunity Law or Regulation.


I understand nothing contained in the application, or conveyed during an interview, is intended to create an employment contract. I understand and agree if I am hired, my employment will be “at will”, without fixed term and may be terminated at any time with or without cause and without prior notice at the option of myself or the company. No premises regarding employment have been made to me. I understand that no such promise or guarantee is binding on the company, unless in writing and includes the Company President’s signature.


If I am offered employment, I agree to submit to a medical exam and drug testing before starting work. If employed, I also agree to submit to a medical examination or drug test at any time deemed appropriate by the company and as permitted by law. I consent to such examinations and test and I request that the examining doctor disclose to the company the results of the examination, which results must remain confidential and segregated from my personnel file. I understand my employment or continued employment to the extent permitted condition of my employment will be that I abide by the company’s drug and alcohol policy. I understand that filling out this form does not indicate there is a position open and does not obligate the company to hire me. I agree to abide by all company work rules, practices and procedure and agree to abide by provisions in the employee handbook if one is provided to me.


I acknowledge the company retains the right to revise its policies and procedures in part or in whole at any time.

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