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Address Line 1
Address Line 2
District of Columbia
Social Security Number (SSN)
What position are you applying for?
The number of hours you are available to work weekly?
Can you work weekends?
Yes, I can work weekends.
No, I can not work weekends.
When is your start date?
What is your desired hourly pay?
Have you been convicted of a felony?
Yes, I have been convicted of a felony.
No, I have not been convicted of a felony.
I prefer not to say.
If you have been convicted of a felony, use this space for a brief description.
Do you have a valid drivers license?
Yes, I have a valid drivers license
No, I do not have a valid drivers license
Any accidence in the last 3 years?
Yes, I have been in an accident.
No, I have not been in any accidents.
Have you received a ticket in the last 3 years?
Yes, I have received a ticket in the last 3 years.
No, I have not received a ticket in the last 3 years.
Are you a U.S. Citizen?
If no, are you allowed to work in the U.S.?
Yes, I am allowed to work in the U.S.
No, I am not allowed to work in the U.S.
Drivers License Number
If you do not have a driver's license number, please enter your form of identification number.
Have you ever worked for Versa Drain, Inc.?
Yes, I have worked for Versa Drain, Inc.
No, I have not worked for Versa Drain, Inc.
If yes, enter your end date below.
If you have references, that we can contact, please complete the form below.
Please use this space to summarize any additional information necessary to describe your full qualifications for the specific position you are applying for.
Please read carefully
Application form waiver. In exchange for the consideration of my job application by Versa Drain, Inc. (hereinafter called “the Company”), 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 The Company , 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 the President /General Manager of the Company. Both the undersigned and The Company 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 sixty (60) 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.
Date / Time