Employment Application

Section 1: Personal Information

First Name*

Middle Name*

Last Name*

Street Address*

City/State*

Zip Code*

For how long have you lived at this residence?*

Phone Number*

Email*

What position are you applying for?*

Geographically where is the position you're applying for?*

If you were referred by an employee, please include their first and last name:

How did you become aware of the position?*

Do you have a valid driver's license?* YesNo

Are you legally eligible to be employed?*
If you are offered a position with our company, you will be required to furnish proof of your eligibility to be employed in the U.S.A. This documentation can take the form of a Social Security card, driver’s license, passport, etc.YesNo

Do you have reliable transportation to and from work?* YesNo

If NOT, how do you intend to arrive to work on time consistently?

Have you ever agreed to or signed a non-competition agreement with your present or a prior employer(s)?* YesNo

If you responded yes to the question above, will this prohibit you from accepting a position with our company?

Section 2: Education

What is the highest level of education you have received? Less than 8th grade89101112GEDCollege 1College 2College 3College 4More

High School Name and City

Did you receive a diploma or GED? DiplomaGED

Name of college, trade school, etc:

Institution Location:

Course of study:

Did you graduate? YesNo

Section 3: Employment History

Please list all the jobs you have held in the last 5 years. Account for ALL time periods including periods when you were not employed, self-employed, or serving in the U.S. Military.

Position 1 Start Date*

Position 1 End Date*

Position 1 Company Name*

Position 1 Company Phone Number*

Position 1 Job Title*

Position 1 Location*

Position 1 Reason for Leaving*

Position 2 Start Date*

Position 2 End Date*

Position 2 Company Name*

Position 2 Company Phone Number*

Position 2 Job Title*

Position 2 Location*

Position 2 Reason for Leaving*

Position 3 Start Date*

Position 3 End Date*

Position 3 Company Name*

Position 3 Company Phone Number*

Position 3 Job Title*

Position 3 Location*

Position 3 Reason for Leaving*

Position 4 Start Date*

Position 4 End Date*

Position 4 Company Name*

Position 4 Company Phone Number*

Position 4 Job Title*

Position 4 Location*

Position 4 Reason for Leaving*

Section 4: Additional Information

Have you ever served in the armed forces of the United States?* YesNo

Are you currently continuing your education in a formal manner? If yes, please explain:

Please list the times and days of the week that you are available to work:

Available to work any day or time?* YesNo

Sunday: until

Monday: until

Tuesday: until

Wednesday: until

Thursday: until

Friday: until

Saturday: until

If offered a position, when would you be available to start?*

If you were offered a position, would you be able to perform the essential functions of the position applied for, with or without any reasonable accommodation(s)? If no, please explain

Are you currently certified in CPR/first-aid?* YesNo

Are you willing to travel for work?* YesNo

Are you willing to stay overnight for work?* YesNo

Tell us a little bit about yourself.*

How do you plan to be successful at work?*

Why should we hire you instead of the other people who have applied for this position?*

Background Check Notification and Waiver

The Company reserves the right to terminate the employment relationship with any and all employees at any time for any reason. This policy cannot be amended except in writing directed to the employee personally by the President. Our Company also reserves the right to make unilateral changes in employment policies and assignments as needed. I understand that I may at any time be required to be tested for the presence of illegal drugs in my body as part of my employment and the presence of such a drug may result in disciplinary action up to and including termination.This application will be considered active for 30-days from the date that it is submitted. For consideration after this initial 30-day period, applicants will be responsible for submitting a new application. Inactive applications will be maintained for a period of two years from the date that they are submitted.I do hereby authorize you to furnish information and release from liability any person or organization who gives or receives information requested by our company. This information may include, but is not limited to: work histories, personal histories, educational histories, criminal histories, etc. I also agree to hold harmless any source for any error in reporting information. I release all persons from damage resulting from furnishing said information. I understand that under Bullard-Plawecki Employee Right to Know Act, I may have a right to notice when my employers and former employers release information about me to your company and I waive all such notice. I authorize your company to photocopy this document and agree that such photocopies with my signature shall have the same legal force and effect as the original document with my signature.

A Summary of Your Rights Under the Fair Credit Reporting Act

The federal Fair Credit Reporting Act (FCRA) is designed to promote accuracy, fairness, and privacy of information in the files of every "consumer reporting agency" (CRA). Most CRAs are credit bureaus that gather and sell information about you -- such as if you pay your bills on time or have filed bankruptcy -- to creditors, employers, landlords, and other businesses. You can find the complete text of the FCRA, 15 U.S.C. §§1681-1681u. The FCRA gives you specific rights, as outlined below. You may have additional rights under state law. You may contact a state or local consumer protection agency or a state attorney general to learn those rights.

* You must be told if information in your file has been used against you. Anyone who uses information from a CRA to take action against you -- such as denying an application for credit, insurance, or employment -- must tell you, and give you the name, address, and phone number of the CRA that provided the consumer report.

* You can find out what is in your file. At your request, a CRA must give you the information in your file, and a list of everyone who has requested it recently. There is no charge for the report if a person has taken action against you because of information supplied by the CRA, if you request the report within 60 days of receiving notice of the action. You also are entitled to one free report every twelve months upon request if you certify that (1) you are unemployed and plan to seek employment within 60 days, (2) you are on welfare, or (3) your report is inaccurate due to fraud. Otherwise, a CRA may charge you up to eight dollars.

* You can dispute inaccurate information with the CRA. If you tell a CRA that your file contains inaccurate information, the CRA must investigate the items (usually within 30 days) by presenting to its information source all relevant evidence you submit, unless your dispute is frivolous. The source must review your evidence and report its findings to the CRA. (The source also must advise national CRAs – to which it has provided the data --of any error.) The CRA must give you a written report of the investigation, and a copy of your report if the investigation results in any change. If the CRA's investigation does not resolve the dispute, you may add a brief statement to your file. The CRA must normally include a summary of your statement in future reports. If an item is deleted or a dispute statement is filed, you may ask that anyone who has recently received your report be notified of the change.

* Inaccurate information must be corrected or deleted. A CRA must remove or correct inaccurate or unverified information from its files, usually within 30 days after you dispute it. However, the CRA is not required to remove accurate data from your file unless it is outdated (as described below) or cannot be verified. If your dispute results in any change to your report, the CRA cannot reinsert into your file a disputed item unless the information source verifies its accuracy and completeness. In addition, the CRA must give you a written notice telling you it has reinserted the item. The notice must include the name, address and phone number of the information source.

* You can dispute inaccurate items with the source of the information. If you tell anyone -- such as a creditor who reports to a CRA – that you dispute an item, they may not then report the information to a CRA without including a notice of your dispute. In addition, once you've notified the source of the error in writing, it may not continue to report the information if it is, in fact, an error.

* Outdated information may not be reported. In most cases, a CRA may not report negative information that is more than seven years old; ten years for bankruptcies. Access to your file is limited. A CRA may provide information about you only to people with a need recognized by the FCRA – usually to consider an application with a creditor, insurer, employer, landlord, or other business.

* Your consent is required for reports that are provided to employers, or reports that contain medical information. A CRA may not give out information about you to your employer, or prospective employer, without your written consent. A CRA may not report medical information about you to creditors, insurers, or employers without your permission.

* You may choose to exclude your name from CRA lists for unsolicited credit and insurance offers. Creditors and insurers may use file information as the basis for sending you unsolicited offers of credit or insurance. Such offers must include a toll-free phone number for you to call if you want your name and address removed from future lists. If you call, you must be kept off the lists for two years. If you request, complete, and return the CRA form provided for this purpose, you must be taken off the lists indefinitely.

* You may seek damages from violators. If a CRA, a user or (in some cases) a provider of CRA data, violates the FCRA, you may sue them in state or federal court.

The facts and statements set forth by me in this application for employment with this company are true and complete. I understand that any false statements or omission of information on this application or any attachment shall be sufficient cause for myself to not be considered for employment. I also understand that, if employed, any false statement or omission on this application or any attachment shall be sufficient cause for dismissal. I acknowledge that I have been advised of my rights under the Fair Credit Reporting Act and I authorize STT, Inc. to obtain a report from a Consumer Reporting Agency by signing this document. If a report is requested, I have been advised that I can be provided with a copy of the report upon my request. This authorization is in accordance with the Fair Credit Reporting Act.

An Equal Opportunity Employer

Digital Signature: By selecting I Accept the facts and statements set forth by me in this application for employment with this company are true and complete. I understand that any false statements or omission of information on this application or any attachment shall be sufficient cause for myself to not be considered for employment. I also understand that, if employed, any false statement or omission on this application or any attachment shall be sufficient cause for dismissal. I acknowledge that I have been advised of my rights under the Fair Credit Reporting Act and I authorize STT, Inc. to obtain a report from a Consumer Reporting Agency by signing this document. If a report is requested, I have been advised that I can be provided with a copy of the report upon my request. This authorization is in accordance with the Fair Credit Reporting Act.*

I AcceptI Don't Accept