Agreement Read the following carefully and check the box to signify your agreement
APPLICANT’S CERTIFICATION, AUTHORIZATION AND AGREEMENT
PLEASE READ CAREFULLY BEFORE SIGNING. IF YOU HAVE ANY QUESTIONS REGARDING THE APPLICATION
OR THE FOLLOWING STATEMENTS, PLEASE ASK FOR ASSISTANCE.
I certify that to the best of my knowledge and belief, the answers given by me to the foregoing questions and the statements made by me in my employment application are true and complete. I understand that any false and/or misleading statements or omissions contained in my employment application may result in my immediate discharge if such information is discovered after I have become employed by HIS – Stonecliffe, Inc. (referred to as the “Employer”).
BACKGROUND INVESTIGATION
I authorize the schools, references and my prior employers listed on my employment application to provide my educational record, employment record, reason for leaving, and all other information they may have concerning me which may lawfully be disclosed. I further authorize the Employer to conduct an investigation into my motor vehicle record and criminal conviction history to determine my suitability for employment. I agree to release all parties (including the Employer) and their respective employees and agents, from any and all liability for disclosing information about me which may lawfully be disclosed and/ or making employment decisions concerning me based on that information. I specifically waive prior written notice of disclosure of my information to Employer.
I further understand and agree that if I am hired prior to the Employer receiving requested information concerning me, my employment may be terminated based upon the later receipt of information that the employer in its sole discretion deems unsatisfactory. I hereby release and hold harmless the Employer (and all of its employees or agents) from any and all liability, claims or causes of action which may arise as a result of such termination.
I further understand and agree that if the Employer learns, after making a conditional offer of employment, that I have a health condition or disability that prevents me from performing the job, the conditional offer of employment may be withdrawn.
ALCOHOL AND DRUG TESTING
If I am employed by the Employer, I agree not to use or possess alcohol or illegal drugs at work, or to work under the influence of alcohol or illegal drugs. I understand that I will be discharged immediately by the Employer for violating these rules. If I am employed by the Employer, I will provide a urine and/or blood specimen under the following circumstances to a laboratory designated by the Employer at any time, with little or no advance notice in order to maintain the validity of the test:
- (1) If the Employer has cause to believe that I am under the influence of alcohol or illegal drugs; or
- (2) If I have been involved in an on-the-job accident resulting in personal injury or property damage.
The detected presence of alcohol or illegal drugs will be grounds for discharge. My failure or refusal to provide a urine and/or blood specimen when requested by the Employer under the above circumstances will also be grounds for discharge.
“AT WILL” EMPLOYMENT
I understand and agree that should I be hired, the Employer may terminate my employment at any time, with or without cause, and with or without notice. No person other than the CEO or COO of the Employer has the authority to make any agreement to the contrary, and any such agreement must be in writing and signed by the CEO or COO of the Employer to be enforceable. I agree to conform to the rules and policies of the Company, including the dispute resolution procedures contained in the Employee Handbook.
VERIFICATION
By checking this box, I hereby certify that I have completely read the foregoing and knowingly and voluntarily agree to each and every condition of employment set forth above.
Prior Work History Beginning with the most recent place you have worked, list your past employers below
Add Work History
Are you over the age of eighteen?
If no, hire is subject to verification that you are of minimum legal age.
Are you either a U.S. Citizen or a non-citizen authorized to work in the U.S.?
Educational Background
Military Service Record
Have you ever served in the armed forces?
If “Yes”, which branch?
Dates of duty: From
MM/DD/YYYY
to
MM/DD/YYYY
Rank at discharge
Type of Discharge
What were your duties in the Service? (Include special training and duty station)
Driving Record
Do you have a valid driver’s license?
If yes, give expiration date:
If “Yes”, indicate type:
or
License Number
State
Have you been involved in any automobile accidents within the last 24 months?
If “Yes”, give details
Business References