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References

List names, addresses and relationships of three persons and related to you who know your qualifications:

1*

2*

3*

Certification

I hereby certify that the answers given by me to the foregoing questions and statements are true and correct to the best of my knowledge without consequential omissions of any kind. I agree that the company shall not be held liable in any respect, if my employment is rejected or subsequently terminated, regardless of time of discovery, because of false statements, answers or omissions made by me in this application. I understand that any misleading or incorrect statements may render this application void, and if employed, may lead to employment termination. I consent to a drug test and a criminal history background check, as a part of the regular pre-employment screening. I also voluntarily and knowingly authorize the companies; schools or persons named herein to give any information requested regarding my former employment, character and qualifications. I hereby voluntarily and knowingly fully release and discharge, absolve, indemnify, and hold harmless said companies, schools or persons from any and all liability for any damages for issuing this information, except for the malicious and willful disclosure of derogatory facts concerning my employment made for the express purpose of preventing me from obtaining employment, I agree to conform to the rules and regulations of this organization. I further authorize that the company I am applying for with this application to rely upon and use, as it sees fit, any information received from such contacts. Information contained on this application may be disseminated to other agencies, nongovernmental organizations or systems on a need-to-know basis for good cause shown as determined by the company head or designee. Employment At-Will States only: Your employment relationship is based upon the mutual consent of you and the company and you are employed on an at-will basis. Employment at-will, compensation and this agreement may be terminated with or without notice at any time by the employee or the Company. Nothing in the employee manual shall limit the right to terminate at-will employment. No manager, supervisor, or employee of the company has any authority to enter into an agreement for the employment for any specified period of time or to make an agreement for employment on other than at-will terms. Only the president of the company has the authority to make any such agreement, which is binding only if it is in writing.*

By checking this box, I affirm that all of the answers given by me above are true and accurate as to the best of my knowledge. I acknowledge and I have read the above statements and accept all conditions.

Consumer Reports Releasse

In connection with my application for: a)employment (including contract for services), or b) residency, I understand that consumer reports or investigate consumer reports which may contain public record information, may be requested or made on me including consumer credit, criminal background search, driving record, education, prior employer verification, workers compensation claims and others. These reports will include experience along with reasons for termination of past employment. Further I understand that you will be requesting information from Federal, State and local agencies regarding my past activities. I hereby authorize without reservation, any party or agency contacted by this employer to furnish the above-mentioned information. I understand I have the right to make a request of the Consumer Reporting Agency, upon proper identification and the payment of any authorized fees, the information in its files on me at the time of my request. I further authorize ongoing procurement of the above-mentioned reports at any time during my employment (or contract).

Professional License

State

Number

*If you retain a driver’s license with special privileges (Such as a CDL) please specify the type of license above, along with the state the license is valid in as well as the driver’s license number. If you have a standard driver’s license please leave the above fields blank.

Drug Free Workplace

Go Green is a drug free workplace. All new employees are drug tested. This shall be paid by the company, but this cost will deducted from the last paycheck of any employee who does not remain with company for a 90-day period.*

By checking this box, I acknowledge I have read the above statement and accept this condition

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Comments

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Careers

Step 1 of 4

Employment History

Education

Personal Information

References

Certification

Consumer Reports Releasse

Drug Free Workplace