References: List the names of three people to whom you are not related who you have known at least three years. * Please Read Carefully Before Signing.
Excell Refrigeration Inc is an equal opportunity employer. Excell Refrigeration Inc does not discriminate in employment on account of race, color, religion, national origin. citizenship status, ancestry, age, sex, sexual orientation. marital status. physical or mental disability, military status. I understand that neither the completion of this application nor any other part of my consideration for employment establishes any obligation for Excell Refrigeration Inc to hire me. If I am hired, I understand that either Excell Refrigeration Inc or I can terminate my employment at any time and for any reason, with or without cause and without prior notice. I understand that no representative of Excell Refrigeration Inc has the authority to make any assurance to the contrary.
I attest with my signature below that I have given to Excell Refrigeration Inc true and complete information on this application. No requested information has been concealed. I authorize Excell Refrigeration Inc to contact references provided for employment reference checks. If any information I have provided is untrue, or if I have concealed material information, I understand that this will constitute cause for the denial of employment or immediate dismissal.
Today's Date (This application is valid for 60 days only after dating and signing.) *
MM slash DD slash YYYY
Your Name * PRE-EMPLOYMENT INFORMATION DISCLOSURE NOTICE AND ACKNOWLEDGEMENT FOR EMPLOYER EXCELL REFIGERATION
Name * Social Security No. * Any other name(s) used in the past or present * Address * City, State, Zip Code * Driver's License No., State * Date of Birth *
In applying for employment with Excell Refrigeration Inc, (“Company”) I hereby authorize the Company, or any designated agent(s) working on the Company’s behalf, including but not limited to reporting agencies or professional investors to obtain and review those reports checked off below as well as following up on information presented in the reports. The Company, or its agents may also request these reports and information during any employment as a condition of continued employment. My consent extends to any possible investigations performed during the employment, including those related to complaints of discrimination, harassment, theft of other conduct. It is my understanding the information being obtained will not be used in violation of federal or state equal opportunity laws or regulation, and that, before any adverse action is taken, based on review of such consumer credit report, I will be provided with a copy of said report as well as a summary of consumer’s rights. I understand the nature and scope of said inquiries may include, but are not limited to, verification, inspection and/or reporting of any lawfully available records of information pertaining to work history; social security number, education, worker’s compensation claims, criminal and civil court related actions, driving history (including traffic related offenses);personal financial status (including consumer credit reports); and any other information available from any public or otherwise documented record. It may also include inquires regarding any past or present business, professional or personal activities. I hereby state that to the best of my knowledge all information I have provided to the Company, and any reporting agency, in any form, is true and accurate. I understand that any misrepresentation made to the Company or reporting agency by me will exclude me from further Consideration as a candidate for employment or advancement and may result in termination of my employment with the Company if I am hired or advanced by the Company before such misrepresentation is discovered. I fully understand this authorization, waiver and release of liability is not an offer or a contract for employment by the Company. It is also understood that the Company operates under an “at will” employment policy and that this authorization and release does not alter or affect this policy in any manner.
Authorization to Obtain Criminal Background Report
I hereby authorize the Company, or reporting agency or investigator to request, obtain and examine any and all records that may relate to my arrest, conviction and/or imprisonment at any time prior to this date, to the extent permitted by law.
Initial Authorization to Obtain Credit Report
I hereby authorize the Company, or reporting agency or investigator to make inquiry into, investigate, and examine any all records that may relate to my current or past credit worthiness; such information to include (but no be limited to) a retail credit report provided by any of the commercial retail credit reporting companies.
Initial Authorization to Obtain Background Report
I hereby authorize the Company or reporting agency or investigator to request and employment background report.
Initial Authorization to Obtain Motor Vehicle Record (MVR)
I hereby authorize the Company or reporting agency or investigator to acquire and examine a copy of my current Motor Vehicle Record.
Initial Authorization to Obtain Past Workers Compensation History and Medical Information
I hereby authorize the Company or reporting agency or investigator or physician to acquire and examine, after a conditioned job offer, information about past workers compensation claims and medical history
Initial Authorization to Conduct Post-Hire Investigation
I hereby authorize the Company or reporting agency or investigator to obtain reports or conduct investigations as a condition of continued employment.
For Information on your rights under the Fair Credit Reporting Act, Please go to www.frc.gov
Note: A copy of this form shall be valid as the Original .
EXCELL REFRIGERATION MVR CONSENT FORM
In conjunction with my potential employment at EXCELL REFRIGERATION INC. I consent to the release of my Motor Vehicle Records (MVR) to the company. I understand the company will use these records in connection with matters of motor vehicle or driver safety that may be related to the position for which I am applying.
I also consent to the review and evaluation of the MVR I have provided to the company and understand that release of the MVR does not necessarily mean I will be hired for a driving, or any other position.
This consent is given in satisfaction of Public Law 18 USC 2721 et.Seq., “Federal Drivers Privacy Protection Act”, and is intended to constitute “written consent” as required by this Act.
Name Name as it Appears on Driver's License, State Date CONSUMER CREDIT AND BACKGROUND REPORT RELEASE FORM. PLEASE READ CAREFULLY.
BY MY SIGNATURE BELOW I AUTHORIZE:
Excell Refrigeration Inc to obtain a Consumer Credit Report and/or a Background Report on me.
This authorization is valid for purpose of verifying information given pursuant to employment, leasing, rental, business negotiations, or any other lawful purpose covered under the
Fair Credit Reporting Act (FCRA)
The Background Check may contain information available in the Public Domain but, may not include interviews with persons other than previous employers or their agents.
By my signature below, I hereby authorize all corporations, former employers, credit agencies, educational institutions, law enforcement agencies, city, state, country and federal courts and agencies, military services and persons to release all information they may have about me including criminal and driving history. This authorization shall be valid in original or copy form.
Applicant Name Social Security No. Date of Birth Current Street Address City, State, Zip Code Driver's License No., State Signature Date
NOTE: PLEASE PROVIDE A COPY OF A VALID DRIVER’S LICENSE
This field is for validation purposes and should be left unchanged.