Employment

APPLICANTS SELECTED WILL BE TESTED FOR ILLEGAL DRUGS
Personal Information
Date*
MM slash DD slash YYYY
Name*
First Middle Last
Maiden Name (If Applicable)
Present Address*
Street Address City State ZIP Code
Length of time at residence*
If under 18, please list age
Phone*
Social Security No.*
Application & Education
Position & Salary*
Position Applying For Desired Salary (Please be Specific)
Days & Hours Available to Work*
Day Hours
How Many Hours Can You Work Weekly?*
Can You Work Nights?*
- Yes
- No
Desired Employment*
- Full-Time Only
- Part-Time Only
- Full-Time or Part-Time
When Would You be Available to Begin Working?*
School/Education*
School Type School Name School Address Years Completed Major/Degree
Have You Ever Been Convicted of a Crime?*
- Yes
- No
If yes, explain number of conviction(s), nature of offense(s) leading to conviction(s), how recently such offense(s) was/were committed, sentence(s) imposed, and type(s) of rehabilitation.*

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Driver's License
Do You Have a Driver's License?*
- Yes
- No
Driver's License No.
State of Issue*
License Type*
- Operator
- Commercial (CDL)
- Chauffeur
What is Your Means of Transportation to Work?*
Have you had any accidents during the past three years?*
- Yes
- No
How many?*
Have you had any moving violations during the past three years?*
- Yes
- No
How many?*
References
Please list two references other than relatives or previous employers.
Reference Name*
Position*
Company*
Phone*
Address*
Street Address City State ZIP Code
Reference Name*
Position*
Company*
Phone*
Address*
Street Address City State ZIP Code
An application form sometimes makes it difficult for an individual to adequately summarize a complete background. Use the space below to summarize any additional information necessary to describe your full qualifications for the specific position for which you are applying.

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Military
Have you ever been in the Armed Forces?*
- Yes
- No
Are you now a member of the National Guard?*
- Yes
- No
Specialty*
Date Entered*
MM slash DD slash YYYY
Date Discharged*
MM slash DD slash YYYY
Date Entered*
MM slash DD slash YYYY
Date Discharged*
MM slash DD slash YYYY
Work History
Please list your work experience for the past 10 years beginning with your most recent job held. If you were self-employed, give firm name.
Employer 1
Company Name*
Address*
Street Address City State ZIP Code
Supervisor Name*
Job Title*
Employment Start Date*
MM slash DD slash YYYY
Employment End Date*
MM slash DD slash YYYY
Pay/Salary at Start of Employment*
Pay/Salary at End of Employment*
Reason for Leaving (Please be Specific)*
List the jobs you held, duties performed, skills used or learned, advancements or promotions while you worked at this company.
Employer 2
Company Name*
Address*
Street Address City State ZIP Code
Supervisor Name*
Job Title*
Employment Start Date*
MM slash DD slash YYYY
Employment End Date*
MM slash DD slash YYYY
Pay/Salary at Start of Employment*
Pay/Salary at End of Employment*
Reason for Leaving (Please be Specific)*
List the jobs you held, duties performed, skills used or learned, advancements or promotions while you worked at this company.
Additional Employment
If there are other employers or work experiences you wish to add, please list the appropriate information in the space below.
May we contact your present employer?*
- Yes
- No
Did you complete this application yourself?*
- Yes
- No
If not, who did?*

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Applicant Form Waiver
PLEASE READ CAREFULLY

In exchange for the consideration of my job application by SITE-SAFE, Inc., I agree that:

Neither the acceptance of this application nor the subsequent entry into any type of employment relationship, either in the position applied for or any other position, and regardless of the contents of employee handbooks, personnel manuals, benefit plans, policy statements, and the like as they may exist from time to time, or other Company practices, shall serve to create an actual or implied contract of employment, or to confer any right to remain an employee of SITE-SAFE, Inc., or otherwise to change in any respect the employment-at-will relationship between it and the undersigned, and that relationship cannot be altered except by a written instrument signed by a Company Representative. Both the undersigned and SITE-SAFE, Inc. may end the employment relationship at any time, without specified notice or reason. If employed, I understand that the Company may unilaterally change or revise their benefits, policies and procedures and such changes may include reduction in benefits.

I authorize investigation of all statements contained in this application. I understand that the misrepresentation or omission of facts called for is cause for dismissal at any time without any previous notice. I hereby give the Company permission to contact schools, previous employers (unless otherwise indicated), references, and others, and hereby release the Company from any liability as a result of such contract.

I also understand that (1) the Company has a drug and alcohol policy that provides for pre-employment testing as well as testing after employment; (2) consent to and compliance with such policy is a condition of my employment; and (3) continued employment is based on the successful passing of testing under such policy. I further understand that continued employment may be based on the successful passing of job-related physical examinations.

I understand that, in connection with the routine processing of your employment application, the Company may request from a consumer reporting agency an investigative consumer report including information as to my credit records, character, general reputation, personal characteristics, and mode of living. Upon written request from me, the Company, will provide me with additional information concerning the nature and scope of any such report requested by it, as required by the Fair Credit Reporting Act.

I further understand that my employment with the Company shall be probationary for a period of ninety (90) days, and further that at any time during the probationary period or thereafter, my employment relation with the Company is terminable at will for any reason by either party.
Applicant Digital Signature*
Date Signed*
MM slash DD slash YYYY
This Company is an equal employment opportunity employer. We adhere to a policy of making employment decisions without regard to race, color, religion, sex, sexual orientation, national origin, citizenship, age or disability. We assure you that your opportunity for employment with this Company depends solely on your qualifications.

Thank you for completing this application form and for your interest in our business.

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Employment

IAS Employment Application

Step 1 of 4

Personal Information

Application & Education

Driver's License

References

Military

Work History

Employer 1

Employer 2

Additional Employment

Applicant Form Waiver

PLEASE READ CAREFULLY

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Position Applying For	Desired Salary (Please be Specific)

Day	Hours

School Type	School Name	School Address	Years Completed	Major/Degree