Home - Best Way Disposal



EMPLOYMENT APPLICATIONNon-CDL EmployeesAPPLICANT INFORMATIONLast Name FirstM.I.DateStreet Address:Apartment/Unit #City:State:Zip Code:Phone: ( )E-Mail Address:Are you 18 or older?Date Available:Desired Salary:Position Applied For:Do you have current and unrestricted authorization to work in the United States? Yes __ No __Have you ever worked for this company? Yes __ No __ If so, when?Have you ever been convicted of a crime or arrested for a felony that has not been expunged by a court? Yes ___ No ___ If Yes, please provide date, nature of incident, and disposition: __________________________________________________________________________________________________________________________________________________________________________________(This will not automatically disqualify you for a particular job)EDUCATIONHigh School:Address:Did you graduate? Yes __ No __DegreeCollege:Address:Did you graduate? Yes __ No __DegreeOther:Address:Did you graduate? Yes __ No __DegreeREFERENCESFull NameRelationshipCompanyPhone ( )AddressFull NameRelationshipCompanyPhone ( )AddressFull NameRelationshipCompanyPhone ( )AddressPREVIOUS EMPLOYMENTCompany:Phone: ( )Address:Supervisor:Job Title:Starting Salary $Ending Salary $Responsibilities:From: To:Reason for LeavingMay we contact your previous supervisor for a reference? Yes _____ No _____Company:Phone: ( )Address:Supervisor:Job Title:Starting Salary $Ending Salary $Responsibilities:From: To:Reason for LeavingMay we contact your previous supervisor for a reference? Yes _____ No _____Company:Phone: ( )Address:Supervisor:Job Title:Starting Salary $Ending Salary $Responsibilities:From: To:Reason for LeavingMay we contact your previous supervisor for a reference? Yes _____ No _____DISCLAIMER AND SIGNATUREI certify that I have read and understand the application and that all statements contained herein are true. I further understand that any falsification or willful omission shall be sufficient cause for dismissal or refusal of employment. Signature:Date:EMPLOYMENT POLICIES AND RELEASE FORMThere are a number of company policies that an applicant needs to know about and agree to before being employed. There also are a number of activities that this company may want to investigate as a part of the review and investigation of the appropriate background information on an applicant. The purpose of this document is to present these policies and investigative activities to the applicant to ensure that they are understood and agreed to at the time the application is submitted.We, therefore, ask that you please read, complete, and sign this form before you complete the Application for Employment.PoliciesAmong the policies that have been adopted at this company are the following which we believe are important for an applicant to know in advance of employment. They are listed below. Your signature on this Release Form indicates that you have read, understand, and would agree to operate under these policies and procedures.This is an equal opportunity employer and does not discriminate because of age, sex, race, color, national origin, disability, religion, height, weight, marital status, ancestry or veteran status. This company is a drug and alcohol free workplace. To ensure worker safety and integrity of the workplace, we prohibit the illegal manufacture, possession, distribution or use of controlled substances or alcohol in the workplace by its employees or those who engage or seek to engage business. Offers of employment, therefore, may be conditioned on a physical examination, including a drug and alcohol screening.Your signature on this Release Form indicates that you understand and agree that if employed, that employment is on an "at-will" basis, for no definite period, and may be terminated by you or this company at any time with or without reason or previous notice.An offer of employment must originate from the company.The following investigative activities may be conducted as part of the background review of prospective employees. Your signature on this Release Form indicates you understand these activities and you authorize them to be performed with the conditions specified as listed below.1. Certain positions at this company may not be held by persons convicted of specific crimes; if applying for such a position, you authorize this company to undertake a criminal records check with state police officials. 2. You authorize this company to obtain a Motor Vehicle Record report. Our insurance company may also obtain a report through its sources. If the position you are applying for involves driving a motor vehicle, it is imperative that a good driving record exists.You also authorize and request any and all of your former employers to furnish any and all information regarding your job performance. You agree to hold your former employers and their agents harmless from all liability which could relate in any way to the disclosure of private information or an assessment or opinion of your suitability for employment.Printed NameDateSignatureConsent to Obtain Motor Vehicle RecordI give my consent to the release of my driving record (“MVR”) to Best Way Disposal (“Company”) for review. I consent to Company periodically obtaining and reviewing my driving records for the purpose of initial and continued employment. My consent shall remain in effect unless and until revoked by me in writing. _________________________________________________________________Applicant Name (PRINTED) Applicant Date of Birth___________________________________Applicant Signature ____________________________________Applicant Driver’s License Number & State FAIR CREDIT REPORTING ACT DISCLOSURE STATEMENT AND AUTHORIZATIONDisclosureIt is Best Way Disposal’s company policy to perform certain background checks of its employees and applicants. This may include checking your previous employment, criminal and civil history, drug/alcohol test records, educational records, driving records, credit, etc. The report may contain information on your character, general reputation, personal characteristics and mode of living. Thus you may be the subject of a “consumer report” or an “investigative consumer report”. The latter is obtained through personal interviews. We will use this information as part of the basis for our decision regarding your employment. This means that your former employers and others may be contacted and a search of public and private records made. We may not obtain this information without your express written consent. You do not have to consent; however, you will not be eligible for employment unless you agree to permit us to obtain this information. To help us obtain this information we sometimes use a consumer reporting agency. That agency is Concorde, Inc., 1835 Market Street, 12th Floor, Philadelphia, PA 19103, 215-563-5555 or 888-805-8885; . In the event that we intend to make an adverse decision based on any information obtained, we will tell you and provide you with a copy of what we obtain; we will also provide a copy of your rights in the form prescribed by the Consumer Financial Protection Bureau. If you would like a copy of any report that we receive, you can obtain a copy by making that request to us in writing at this time. Acknowledgement and AuthorizationI acknowledge receipt of A SUMMARY OF YOUR RIGHTS UNDER THE FAIR CREDIT REPORTING ACT. I authorize Company and Concorde to make lawful inquiries, including of my prior employers, and other entities and persons to verify my suitability for employment. This may include requests for information regarding my criminal, civil and motor vehicle records. I authorize the release of this information by any prior employer and anyone else having information or documentation about me to Company and Concorde. I authorize Concorde or other consumer reporting agencies to provide consumer and investigative consumer reports to you. I agree that so long as I remain employed by the above named employer, that this Disclosure and Authorization shall remain in effect; accordingly it shall not be necessary for me to sign a new Disclosure and Authorization. □ California, Minnesota and Oklahoma Applicants/Employees: Check the box if you want to receive a copy of any report. California Applicants/Employees: By signing below, you also acknowledge receipt of a copy of the CALIFORNIA NOTICE REGARDING BACKGROUND INVESTIGATION. New York Applicants/Employees: You have a right to receive a copy of any report by contacting Concorde directly. By signing below, you acknowledge receipt of a copy of New York Correction Law Article 23-A.__________________________________________________________________________________________Printed Name of Applicant/Employee Date of Birth Social Security Number__________________________________________________________________________________________Signature Date Telephone Number__________________________________________________________________________________________List Your Current Addresses - Street/City Zip__________________________________________________________________________________________List Your Former Addresses for Last 7 years - Street/City Zip__________________________________________________________________________________________List Your Former Addresses for Last 7 years - Street/City ZipA COPY OF THIS DOCUMENT MAY SERVE AS THE ORIGINALPara informacion en espanol, visite credit o escribe a la FTC Consumer Response Center, Room 130-A 600 Pennsylvania Ave. N.W., Washington, D.C. 20580A Summary of Your Rights Under the Fair Credit Reporting ActThe federal Fair Credit Reporting Act (FCRA) promotes the accuracy, fairness, and privacy of information in the files of consumer reporting agencies. There are many types of consumer reporting agencies, including credit bureaus and specialty agencies (such as agencies that sell information about check writing histories, medical records, and rental history records). Here is a summary of your major rights under the FCRA. For more information, including information about additional rights, go to credit or write to: Consumer Response Center, Room 130-A, Federal Trade Commission, 600 Pennsylvania Ave. N.W., Washington, D.C. 20580.You must be told if information in your file has been used against you. Anyone who uses a credit report or another type of consumer report to deny your application for credit, insurance, or employment – or to take another adverse action against you – must tell you, andmust give you the name, address, and phone number of the agency that provided the information.You have the right to know what is in your file. You may request and obtain all the information about you in the files of a consumer reporting agency (your “file disclosure”). You will be required to provide proper identification, which may include your Social Securitynumber. In many cases, the disclosure will be free. You are entitled to a free file disclosure if:a person has taken adverse action against you because of information in your credit report;you are the victim of identity theft and place a fraud alert in your file;your file contains inaccurate information as a result of fraud;you are on public assistance;you are unemployed but expect to apply for employment within 60 days.In addition, by September 2005 all consumers will be entitled to one free disclosure every 12months upon request from each nationwide credit bureau and from nationwide specialty consumer reporting agencies. See credit for additional information.You have the right to ask for a credit score. Credit scores are numerical summaries of yourcredit-worthiness based on information from credit bureaus. You may request a credit score from consumer reporting agencies that create scores or distribute scores used in residential real property loans, but you will have to pay for it. In some mortgage transactions, you will receive credit score information for free from the mortgage lender.You have the right to dispute incomplete or inaccurate information. If you identify information in your file that is incomplete or inaccurate, and report it to the consumer reporting agency, the agency must investigate unless your dispute is frivolous. See credit for an explanation of dispute procedures.Consumer reporting agencies must correct or delete inaccurate, incomplete, or unverifiable information. Inaccurate, incomplete or unverifiable information must be removed or corrected, usually within 30 days. However, a consumer reporting agency may continue to report information it has verified as accurate.Consumer reporting agencies may not report outdated negative information. In most cases, a consumer reporting agency may not report negative information that is more than seven years old, or bankruptcies that are more than 10 years old.Access to your file is limited. A consumer reporting agency may provide information aboutyou only to people with a valid need -- usually to consider an application with a creditor, insurer, employer, landlord, or other business. The FCRA specifies those with a valid need for access.You must give your consent for reports to be provided to employers. A consumer reporting agency may not give out information about you to your employer, or a potential employer, without your written consent given to the employer. Written consent generally is not required in the trucking industry. For more information, go to credit.You may limit “prescreened” offers of credit and insurance you get based on information in your credit report. Unsolicited “prescreened” offers for credit and insurance must include a toll-free phone number you can call if you choose to remove your name and address from the lists these offers are based on. You may opt-out with the nationwide credit bureaus at 1-888-5-OPTOUT (1-888-567-8688).You may seek damages from violators. If a consumer reporting agency, or, in some cases, auser of consumer reports or a furnisher of information to a consumer reporting agency violates the FCRA, you may be able to sue in state or federal court.Identity theft victims and active duty military personnel have additional rights. For more information, visit credit.States may enforce the FCRA, and many states have their own consumer reporting laws. In some cases, you may have more rights under state law. For more information, contact your state or local consumer protection agency or your state Attorney General. Federal enforcers are:TYPE OF BUSINESS:CONTACT:Consumer reporting agencies, creditors and others not listed belowFederal Trade Commission: Consumer Response Center - FCRA Washington, DC 20580 1-877-382-4357National banks, federal branches/agencies of foreign banks (word"National" or initials "N.A." appear in or after bank's name)Office of the Comptroller of the CurrencyCompliance Management, Mail Stop 6-6Washington, DC 20219 800-613-6743Federal Reserve System member banks (except national banks, and federal branches/agencies of foreign banks)Federal Reserve Consumer Help (FRCH) P O Box 1200Minneapolis, MN 55480Telephone: 888-851-1920Website Address: Email Address: ConsumerHelp@Savings associations and federally chartered savings banks (word"Federal" or initials "F.S.B." appear in federal institution's name)Office of Thrift SupervisionConsumer ComplaintsWashington, DC 20552 800-842-6929Federal credit unions (words "Federal Credit Union" appear in institution's name)National Credit Union Administration1775 Duke StreetAlexandria, VA 22314 703-519-4600State-chartered banks that are not members of the Federal ReserveSystemFederal Deposit Insurance CorporationConsumer Response Center, 2345 Grand Avenue, Suite 100Kansas City, Missouri 64108-2638 1-877-275-3342Air, surface, or rail common carriers regulated by former CivilAeronautics Board or Interstate Commerce CommissionDepartment of Transportation , Office of Financial ManagementWashington, DC 20590 202-366-1306Activities subject to the Packers and Stockyards Act, 1921Department of AgricultureOffice of Deputy Administrator - GIPSAWashington, DC 20250 202-720-7051 ................
................

In order to avoid copyright disputes, this page is only a partial summary.

Google Online Preview   Download