Please read this statement before filling out this application.

This Company does not discriminate in hiring or employment on the basis of race, color, sex, religion, disability, national origin, citizenship, or on the basis of age with respect to persons 18 years or older. No question on this application is intended to secure information to be used for such discrimination. Proof of identity and work authorization will be required upon employment in accordance with federal regulations. This Company intends to check and hold you responsible for the accuracy of the statements you make on this application. This application will receive consideration for thirty (30) days. If you have not heard from the Company within thirty days and wish to receive further consideration for employment, it will be necessary to complete another application form.

Personal Data

Employment

Military Service

Work History

Starting with your last or present job, list 3 former employers.

Employer 1

Employer 2

Employer 3

Education

College:

Technical School / Other:

Relatives in Our Employment

References

Reference 1

Reference 2

Reference 3

Special Skills

Affidavit

By submitting this application, you agree to the following:

I authorize, without liability, investigation of all statements in this application. I authorize all schools which I attended and all previous employers to furnish to the Company my record, reason for leaving, and all other information they may have concerning me, and hereby release them and the Company from all liability for any damage whatsoever arising therefrom.

I authorize my neighbors, friends, or others with whom I am acquainted or who are acquainted with me to furnish the Company with information used in connection with the evaluation of my qualifications as a prospective employee. I release such persons and organizations from any legal liability in making such statements.

I authorize the Company to conduct any background check necessary on my past records, including but not limited to, criminal record checks in places I have lived, a check of my driving record, and a review of my credit record. I release the Company from any liability for any damage whatsoever arising from these investigations.

InServ is a drug-free workplace and I understand I must submit to a pre-employment drug test. If I do not, my application for employment will not be considered. I also understand that if I test positive on my pre-employment drug test, I will not be hired.

I understand that in the event of my employment by the Company, it shall be sufficient cause for dismissal if any of the information I have given in this application is false.

I understand that proof of identity and work authorization will be required upon employment in accordance with federal regulations. In the event of my employment by the Company, I agree to abide by all present and subsequently issued rules of the Company. I further understand that InServ is a service-oriented company and as such may request me to work additional hours on an as needed basis.

Recruitment Survey

This information is for recruitment purposes only. We request that you complete this survey, but your participation is voluntary. Thank you for your consideration and cooperation.

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