Employment Application

Personal Data
(first, middle, last)
Upon employment, can you provide appropriate documentation verifying your identity and your legal right to work in the USA?
Please list any relevant military experience you have.
Vehicle Information
If driving a truck or vehicle is an essential function of the job for which you are applying; please this information.
Job Interest
For what job/position are you applying? (Please be specific)
Who referred you to our Company, or what prompted your application here?
Education and Training
 School Name/LocationMajor Course of Study# of years attendedIf Graduated – List Degree/Certificate title & Date (EXCEPT HIGH SCHOOL)
High School
GED (if applicable)
Trade School
College
Other
Work History
Most Current or Recent Job
PLEASE LIST YOUR JOBS IN THE EXACT ORDER OF OCCURRENCE. PLEASE BEGIN WITH CURRENT JOB OR MOST RECENT JOB IF UNEMPLOYED.
JOB-RELATED BACKGROUND

Special Note/Section to Applicants with Disabilities

You may answer “yes” to question (2) above if you can perform all essential functions of the job with or without reasonable accommodation. The Company will provide reasonable accommodation to a person with a disability.

However, you still are not required to identify yourself as a disabled person on this Application Form.

If you can perform the essential tasks of the job ONLY with an accommodation then please respond to this question:

Do you ever take any illegal drug [such as (but not limited to) methamphetamine, marijuana, cocaine] without a medical prescription? Also, have you taken any illegal drug during the past year without a medical prescription? (Note: A “Yes” answer may not necessarily bar you from employment here.)
Agreement & Release

PLEASE READ THE ENTIRE FOLLOWING SECTION BEFORE SIGNING.

Then please sign this form at the bottom of the page.
Also, please initial each section indicating you have read that section.

WITH THIS APPLICATION BY MY SIGNATURE BELOW I AGREE TO ALL OF THE FOLLOWING TERMS:

I certify that the information I have provided on this Application Form and on my resume (if any) is true to the best of my knowledge.

Regarding this application, I understand that if the Company determines that I have made any false statements, answers or any misrepresentation or any omission of significant information, the Company is entitled to reject my Application, or if hired, to terminate my employment.

In the event I undergo a medical examination or evaluation as a part of the job placement process of the Company I agree to supply only information which is true to the best of my knowledge. Regarding this examination or evaluation, I understand that if the Company determines that I have made any false oral or written statements or answers or any misrepresentation or any omission of significant information to the Company or to the physician or to his or her representative, the Company is entitled to terminate my conditional or actual employment at any time.

I authorize any person, school, current employer, past employer, physician or organization with knowledge of me or my work to provide the Company or its agent or representative with any information or opinion about me in response to an inquiry by the Company. I release any such person, employer, physician or organization from any legal liability in making such statements or furnishing any and all information to the Company or to its representative or agent.

I authorize the Company or its agent or representative to check references regarding my employment and investigate any of the statements or answers provided by me on this Application or made to a physician or his or her representative (in the event of a medical examination or evaluation). The only exception to this authorization is where I have specifically requested in writing on this Application Form on the date below that no such inquiry be made.

I understand that my employment at this Company is on an "at will" (that is, mutual consent) basis. Therefore, I agree that either I or the Company has the proper right to terminate my employment with or without cause at any time.

Please enter your full name.
, by my signature above, herby authorize Rexius, the Medical Review Officer and licensed laboratory selected by Rexius to perform a urinalysis on a urine specimen provided by me to test for drug use. I consent to this test and I also give my permission to the laboratory and Medical Review Officer to release the results of this drug test to Rexius. I agree that Rexius may use these results to determine my suitability for employment.

If I am employed by Rexius I agree to any drug/alcohol testing the Company may require under its Alcohol and Drug Policy. If the laboratory finds the test invalid, and if the laboratory, Medical Review Officer or Rexius believe another test is appropriate, I agree to submit another specimen(s) for further testing.

Enter your full name
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