Name *
Name
Phone number *
Phone number
Address *
Address
Previous Address
Previous Address
Are you 18 or older?
Have you been convicted of a felony?
Will you work weekends?
Will you work nights?
Do you have transportation?
If employed by us, would you be employed with any other organization, or self-employed?
May we contact your present employer for reference?
AUTHORIZATION: In connection with my application for employment (including contract for services) with you, I understand the investigative background inquiries are to be made on myself including consumer, criminal, driving and other reports. These reports will include information as to my character, work habits, performance and experience along with reasons for termination of past employment from previous employers. Further, I understand that you will be requesting information from previous employers. Furthermore I understand that you will be requesting information from various federal, state and other agencies which maintain records concerning my past activities relating to my driving, credit, criminal, civil and other experiences as well as claims involving me in the files of insurance companies. I also understand that as part of the Company's procedure for processing my employment application, an investigation may be made whereby information is obtained through personal interviews with my neighbors, friends, or others with whom I am acquainted. This inquiry includes information as to my character, general reputation, personal characteristics and mode of living. I understand that I have the right to make a written request within a reasonable period of time for a complete and accurate disclosure of additional information concerning the nature and scope investigation. If hired I understand that I can leave at anytime or can be terminated at any time. I also understand my continued employment may be subject to the issuance and continued maintenance of a bond by the bonding agent of the Company. I will abide by all Company policies and procedures and will comply with all safety requirements and wear or use protective clothing or devices required by federal or state law and the Company. If requested, I will take a pre-employment physical examination from a physical designated and paid for by the Company. I agree that if the Company finds I have made any intentional omissions or misrepresentations on this application, it may eliminate me from further consideration or withdraw any offer of employment or terminate my employment with any obligation on its part, except for payment to me for services already rendered. *
Without reservation, I authorize any part or agency contacted by this employer to furnish the above mentioned information.