NOTICE IT IS THE POLICY OF FIRST COLLECTION SERVICES TO DRUG TEST AND TO DO A CRIMINAL. BACKGROUND CHECKe IF YOU USE DRUGS OR HAVE A CRIMINAL

Transcription

1 NOTICE IT IS THE POLICY OF FIRST COLLECTION SERVICES TO DRUG TEST AND TO DO A CRIMINAL BACKGROUND CHECKe IF YOU USE DRUGS OR HAVE A CRIMINAL RECORD, PLEASE DO NOT APPLY WITH THIS COMPANY. Please sign below that you are aware that First Collection Services does a Drug Test and Criminal Background Check. Do not remove this paper from application. Applicant's Signature

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3 CONSENT FOR DRUG TESTING. If you are einployed or are offered and accept einployn1ent with First Collection Services (FCS), in the interest of safety for all concerned, you will be required to take a urine test for drug use. I, have been, fully infonned of the reason for this urine test for drugs (I understand what I mn being tested for), the procedure involved, and do hereby freely give Iny consent. In addition, I understand that the results of this test will be forwarded to Iny potential and/or cunent einployer and becolne part of n1y record. FCS reserves the right to Drug Test at any tilne during your tenure with this con1pany. If this test is positive, and for this reason I an1 not hired or a111 tenninated, I understand that I will be given the 0ppOliunity to explain the results of this test. I hereby authorize these test results to be released to First Collection Services, Otter Creek E. Blvd, Mabelvale, AR Signature Witness Date Date

4 Instructions: It is the policy of the company to provide equal opportunity with regard to all terms and conditions of employment. The company complies with federal and state laws prohibiting discrimination on the basis of race, color, religion, creed, national origin, disability, veteran status, age, or any other protected characteristic. Date of Application Name Home Phone ( Cellular/ Other Phone ( Address City/State/ZIP Position applied for For Offim Use Only Applicant # Employee # Expected salary range or hourly rote of pay Type of work desired Full-time D Part-time D Seasonal D Temporary D Dote available for work How were you referred to this company? Have you ever been employed here before? Yes D No D If yes, give dotes Is this application a request for reemployment following on extended military leave of absence from this company? If Yes, additional information may be requested. Yes D No D If you ore under 18 years old, can you provide a work permit if required? Are you legally eligible for employment in the USA? If Yes, proof is required if hired. Yes D No D Yes D No D Are you able to perform the II essential functions" of the job for which you ore applying (with or without reasonable accommodation)? This question is not designed to elicit information about an applicant's disability. Please do not provide information about the existence of a disability, particular accommodation, or whether accommodation is necessary. These issues may be addressed at a later stage to the extent permitted by law. Yes D No D Need more information about the job's If essential functions" to respond D Will you relocate if required? Ves D No D Will you travel if required? Ves D No D Will you work overtime if required? Ves D No D If driving may be required in the job for which you are applying, please provide your driver's license number. Dl # Have you ever been bonded? Yes D No D State Hire Dote Position Rate Closs _ Skill Other Notes: Attachments o Resume D Applicant Reference Notes D Applicant Interview Notes o Test Results d J R arect '" Item #A B To reorder, visit hrdirect.(om or ( B HRdirecl

5 Place on [Xl by the employer(s) you do not wont us to contact. list your most recent employer first. 1. Employer o Address Job Title Supervisor Phone ( Dotes Employed: from (mm/yy) to (mm/yy) Hourly rote/salary: starting final Work Performed Reason for leaving 2. Employer o Address Job Title Supervisor Phone ( Dotes Employed: from (mm/yy) 10 (mm/yy) Hourly rote/salary: starting final Work Performed Reason for leaving 3. Employer o Address Job Title Supervisor Phone ( Dates Employed: from (mm/yy) to (mm/yy) Hourly rote/salary: starting final Work Performed Reason for leaving 4. Employer o Address Job Title Supervisor Phone ( Dotes Employed: from (mm/yy) to (mm/yy) Hourly rote/salary: starting final Work Performed Reason for leaving

6 Explain any gaps in employment, other than those due to personal illness, injury or disability. Have you ever been fired or asked to resign from a job? Yes 0 No 0 High School: location Nome of school (ourse of study Did you graduate? Yes 0 No 0 Degree or diploma Years completed College: location Nome of school (ourse of study Did you graduate? Yes 0 No 0 Degree or diploma Years completed Graduate School: Nome of school location (ourse of study Did you graduate? Yes 0 No 0 Degree or diploma Years completed Vocational Training - Nome of school Other: location (ourse of study Did you graduate? Yes D No D Degree or diploma Years completed Continuing Educ liion: List any special training, skills, licenses and/or certificates that may assist you in performing the position for which you are applying: Computer Skills (Check appropriate boxes. Include software titles and years of experience.) o Word Processing Years: 0 Internet Years: o Spreadsheet Years: 0 Other Years: o Presentation Years: o Other Years: o Years: o Other Years: Is there any other job-related information you want us to know about you? List names and telephone numbers of three business/work references who are not related to you and are not previous supervisors. If not applicable, list three school or personal references who are not related to you. Nome TItle Relationship to You Telephone Years Known

7 I certify that all the information submitted by me on this applicatian is true and complete, and I understand that if any false or misleading information, omissions, or misrepresentations are discovered, my application may be rejected, and if I am employed, my employment may be terminated at any lime. I expressly authorize, without reservation, the employer, its representatives, employees or agents to contact and obtain information from all references (personal and professional), employers, public agencies, licensing authorities and educational institutions and to otherwise verify the accuracy of all information provided by me in this application, resume or job interview. I hereby waive any and all rights and claims I may have regarding the employer, its agents, employees or representatives, for seeking, gathering and using truthful and non defamatory information, in a lawful manner, in the employment process and all other persons, corporations or organizations for furnishing such information about me. I understand that this application remains active for only 30 days. At the conclusion of that time, if I have not heard from the employer and still wish to be considered for employment, it will be necessary for me to reapply and fill out a new application. In consideration of my employment, I agree to conform to the company's rules and regulations, and I understand that these rules and/or the employee handbook do not form a contract of employment, either expressed or implied, and I agree that my employment and compensation can be terminated, with or without cause and with or without notice, at any time, at either my or the company/s option. I also understand and agree that the terms and conditions of my employment may be changed, with or without cause and with or without notice, at any time by the company. I understand that no company representative, other than its president, and then only when in writing and signed by the president, has any authority to enter into any agreement for employment for any specific period of time, or to make any agreement contrary to the foregoing. Applicant's Signoture Dote This Application for Employment has been prepared far general use throughout the United States. Neither HRdirect nor its counselor advisers assumes any responsibility for the inclusion in the Application far Employment of any questions that may violate local, state, or federollows. Users should consult their legal counsel about any questions they may have concerning this form or its use. Dote Interviewerlsl Tests Administered Dote Score Rating Date Contacted Reference Name Contacted By

8 Background & Criminal Record Search Record Search is FOR (YOUR COMPANY NAME): _ Signed Release Fonn Please Print top portion Name ~ ~~~------~~ A.K.A First Middle Las! Address City IState Zip ~ curren I Previous City/State _ Zi p Previous City/State Zip SSN DOB (For identification only) Drivers License Number State is sued _ LIST ALL CONVICTIONS INCLUDING TRAFFIC AND CRlMINAL Year Criminal Offense(s) Offense County Year Traffic Offense(s) Offense County I hereby authorize the release to Employee Screening Management, Acxiom, ClearStar Logistics an independent contract agency, of infonnation held by any parties regarding my Criminal History information, to include my record of arrests and, or convictions for violations of any federal, state, local statutes or ordinances, my credit history, workers compensation history, driving record and hereby release any said person, companies or law enforcement authorities from any liability for any damage whatsoever for issuing this information. I further understand this infonnation may be reviewed initially and periodically by Employee Screening Management, Acxiom, ClearStar Logistics and reported to my prospective employer. J understand my prospective employer intends to utilize the investigation into my background for employment purposes only, and shall not disclose such infonnation to any other party. J hereby acknowledge that Employee Screening Management, Acxiom, ClearStar Logistics cannot vouch for or guarantee accuracy ofinfonnation provided by third parties. Accordingly, I release Employee Screening Management, Acxiom, ClearStar Logistics its agents and / or my prospective employer from any and all liability arising out of any errors or omissions regarding my background infonnation and authorize Employee Screening Management, Acxiom, ClearStar Logistics to release the results of its investigation to my prospective employer. NOTE: Louisiana driving records are supplied by American Driving Records. Applicant signature:::-;::-= = = =- Date: Signature is required - Please DO NOT PRlNT FOR OFFICE USE ONLY: Must be completed by client before investigation win be performed Cli ent: StorelPlant# Manager: Date: Phone:~ Fax:~ SSN WC Manager, please indicate which reports you require. Employment Education MVR Credit Criminal Reference Prof. CertlLics Drug Screening