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Career Application
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Name *
First, middle (if applicable) and last name
Cell phone number *
E-mail *
Street Address *
City *
State *
Zip *
Date of birth (age is not a consideration in hiring decisions) *
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Are you the subject of any pending criminal charges? *
Required
Driver's License number (write NA if you do not have one) *
When are you available to start work? *
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Please provide us with a professional reference; name and phone number. We will not contact them until after our initial interview *
Use this space if there is anything that you would like to mention
It is our policy to comply with all applicable state and federal laws prohibiting discrimination in employment based on race, age, color, sex, religion, national origin, disability or other protected classifications. I certify that the facts set forth in the above employment application are true and complete to the best of my knowledge. I understand that falsified statements on this application in any detail shall be considered sufficient cause for disqualification from further consideration for hire or for dismissal. I authorize the hiring company (“Company”) to make any investigation of my personal or employment history and authorize any former employer, person, firm, corporation or government agency to give the Company any information they may have regarding me. In consideration of the Company’s review of this application, I release the Company and all providers of information from any liability as a result of furnishing and receiving this information. I further agree that, if hired, my employment can be terminated with or without cause and with or without notice, at any time, at either the Company’s or my option. I understand that no personnel recruiter, interviewer or other representative of the Company other than the President has any authority to enter into any agreement for employment for any specified period of time. I also understand that any employment manuals or handbooks that may be distributed to me during the course of my employment shall not be construed as a contract or contract by implication. I hereby consent to submit to a drug or alcohol test and to furnish a sample of my urine, breath, and/or blood for analysis, as shall be determined by the Company in order to meet with their policy regarding the selection of applicants for employment. I further authorize and give full permission to have the Company and/or its authorized agents and physicians to send the specimen or specimens so collected to a laboratory for a screening test for the presence of any prohibited substances under the policy, and for the laboratory or other testing facility to release any and all documentation relating to such test to the Company. I further agree to and hereby authorize the release of the results of said tests to the Company. I understand that it is the current use of illegal drugs that would prohibit me from being employed at this Company. I further agree to hold harmless the Company and its agents and physicians from any liability arising in whole or part, out of the collection of specimens, testing, and use of the information from said testing in connection with the Company's consideration of my application of employment. I further agree that a reproduced copy of this pre-employment consent and release form shall have the same force and effect as the original. I have carefully read the foregoing and fully understand its contents. I acknowledge that my signing of this consent and release form is a voluntary act on my part and that I have not been coerced into signing this document by anyone. In conjunction with my potential employment at the Company I consent to the release of my Motor Vehicle Records (MVR) to the company. I understand the company will use these records to evaluate my suitability to fulfill driving duties that may be related to the position for which I am applying. I also consent to the review, evaluation, and other use of any MVR I may have provided to the company. This consent is given in satisfaction of Public Law 18 USC 2721 et. Seq., “Federal Drivers Privacy Protection Act”, and is intended to constitute “written consent” as required by this Act. By writing your name below, you are signing this application electronically. You agree your electronic signature is the legal equivalent of your manual/handwritten signature on this agreement. By signing using any device, means or action, you consent to the legally binding terms and conditions of this application. You further agree that your signature on this document (hereafter referred to as your "E-Signature") is as valid as if you signed the document in writing. You also agree that no certification authority or other third party verification is necessary to validate your E-Signature, and that the lack of such certification or third party verification will not in any way affect the enforceability of your E-Signature or any resulting agreement between you and the Company. Please type your name below to sign. *
Date *
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