Step 5 of 5 - Submit Application
Please print, sign, and fax to (314) 219-4760
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TO BE READ AND SIGNED BY THE APPLICANT
· This certifies that I completed this application, and that all entries on it and information in it are true and complete to the best of my knowledge. Any misrepresentation of information given above shall be considered an act of dishonesty and can result in my immediate dismissal or rejection.
· I agree to voluntarily submit to a pre-employment physical, drug screen and a driver evaluation should I meet the qualifications of the position for which I have applied and agree to produce documentation to verify my identity and legal authorization to work in the U.S. as required by the Control Act of 1986. I agree to furnish such additional information and complete such examinations as may be required to complete the employment file on the contingent of a job offer. It is agreed and understood that this application is not a contract for employment and in no way obligates the employer to employ the applicant.
· If hired, I agree to abide by all the rules and policies of the employer. It is also agreed and understood that under the Fair Credit Reporting Act, I have been told that this investigation may include an Investigative Consumer Report, including information regarding my character, general reputation, personal characteristics, and mode of living.
· I hereby certify that all information on this form is correct and complete to the best of my knowledge. I hereby authorize Witte Bros. Exchange Inc. to do a complete background investigation in accordance with state and federal laws. I authorize release of any information, including all information related to my alcohol and controlled substances testing and training records required by the Federal Highway Administration (FHWA) 49 CFR Parts 391 or 382, by any past or current employers. I hereby release all such persons from any liability or damages. I consent to the procurement and use of any consumer reports, including reports from USIS Commercial Services, Inc., deemed necessary by Witte Bros. Exchange Inc. or its subsidiaries in their consideration of my employment. I understand that I have the right to review information provided by previous employers, have errors corrected by previous employer and resubmitted to Witte Bros. Exchange Inc. and/or have a rebuttal statement attached to erroneous information if my previous employer and I cannot agree on the accuracy of the information. I understand that I must request past employer information obtained by Witte Bros. Exchange Inc. in writing within 30-days of my application.
· In connection with your application for employment/contract with Witte Bros. Exchange Inc. it may obtain one or more reports regarding your credit, driving, and/or criminal background history from a consumer reporting agency and/or other sources. If the Prospective Employer/Contractor uses any information it obtains from a background report in a decision to not hire you or to make any other adverse employment/contract decision regarding you, the Prospective Employer/Contractor will provide you with a copy of the report upon which its decision was based and a written summary of your rights under the Fair Credit Reporting Act before taking any final adverse action. If any final adverse action is taken against you based upon a background report, the Prospective Employer/Contractor will notify you that the action has been taken and that the background report was the reason for the action. The Prospective Employer/Contractor cannot obtain background reports from consumer reporting agencies or other sources regarding you unless you consent in writing. If you agree that the Prospective Employer/Contractor may obtain such background reports, please read the following and sign below:
· I authorize Witte Bros. Exchange Inc. to contact any organization or individual that I have listed on my employment/contract application or resume or mentioned in job interviews and obtain from them any relevant information about my job qualifications, including my experience, skills, and abilities. I understand that I am consenting to the release of safety performance information including crash data from the previous five (5) years and inspection history from the previous three (3) years, as well as any reference-related information about me held or known by my former employers, supervisors, and co-workers. In addition, I consent to the release of any information about my education, experience, abilities, or work-related characteristics or traits held or known by other organizations or individuals, including schools and educational institutions, professional or business associates, and friends and acquaintances that Prospective Employer/Contractor might contact in the course of conducting a reference check or background investigation of my suitability for employment/contract.
· I understand and acknowledge that this release of information can involve my qualifications, performance, credentials, or other characteristics or factors affecting my suitability for employment/contract with Prospective Employer/Contractor. Specifically, I am authorizing the release of any information about my performance, experience, capability, attitude, specific events, or other work-related characteristics that currently are in the possession of the requested organizations or their managers or representatives.
· In exchange for Prospective Employer's/Contractor’s consideration of my employment/contract application, I agree not to file or pursue any complaints, claims, or legal actions of any kind against any organization or individual that provides work-related information about me to Prospective Employer/Contractor or its agents in accordance with the terms and intent of this release. I also agree not to file or pursue any complaints, claims, or legal actions against Prospective Employer/Contractor or any of its employees, representatives, or agents arising out of their efforts to obtain work-related information about me.
· I have read the above Notice Regarding Background Reports provided to me by Prospective Employer/Contractor and I understand that if I sign this consent form, Prospective Employer/Contractor and/or any entity it retains to obtain such background reports may obtain reports of my credit, driving, and/or criminal background history in addition to information regarding my background, references, education, specific events, and past employment/contract.
· I hereby authorize Prospective Employer/Contractor and its employees, agents, and affiliates to obtain the information authorized above.
Signature of Prospective Employee |
Date |
Equal Opportunity Employer