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* 1. Name

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* 2. Address

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* 10. Position

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* 11. Date you can start

Date

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* 12. Compensation desired

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* 14. Where?

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* 15. Current rate of pay

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* 17. Which Employee referred you?

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* 20. If previously employed by us- when?

Date

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* 21. High school name and location

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* 22. Number of years attended

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* 24. Please list the last (4) employers, starting with the last one first-

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* 25. Professional References

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* 26. Please upload a copy of your drivers license

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* 27. *I certify that the facts contained in this application are true and complete to the best of my knowledge and understand that if employed, incomplete, false, or misleading statements on this application shall be grounds for dismissal at any time in the future. I understand this application becomes part of my official employment record, if hired.
I authorize investigation of all statements contained herein and the references listed above to give you any and all information concerning my previous employment and any pertinent information they may have, personal or otherwise, and release all parties from all liability for any damage that may result from furnishings same to you. When applicable, I will cooperate with the company in the company's performance of my background check as regulated by the fair credit reporting act.
I also authorize you to obtain information regarding my record at the Bureau of Motor Vehicles.
I understand that pursuant to the company's job application process I may be required to undergo drug testing. I further understand that if I refuse to take or fail the drug test, I am disqualified from further employment consideration. I hereby knowingly and voluntarily consent to the company's request to undergo drug testing.
I further release the company and its officers, agents, representatives and employees from any and all claims and liability for damage associated with or arising from my submission to these tests.
In consideration of my employment, I agree to conform to company rules, regulations and policies, and agree that my employment and compensation can be terminated with or without cause, and with or without notice at any given time, for any reason, at the option of either the company or myself. I understand that no supervisor, manager, officer or representative of the company or any other entity of the company, has any authority to enter into any agreement for providing work for any specific period of time or to make any agreement contrary to the foregoing other than the president and then only in writing. I understand that no promise of a benefit is binding unless made in writing and signed by the president of the company.

READ CAREFULLY BEFORE SIGNING

I agree that any claim or lawsuit relating to my service with the company or any of its subsidiaries must be filed no more than six (6) months after the date of employment action that is the subject of the claim or lawsuit. I expressly waive any statute of limitations to the contrary.

Read, Understood and Agreed

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