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employmentap

By Roberta Hunter,2014-04-15 10:18
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employmentap

    EMPLOYMENT APPLICATION

    Thank you for your interest in applying for a job with Advanced Power Technologies (“APT”). We at APT need you to complete this application so we can determine if your

    credentials are suitable for the position we are considering you for. Please understand that our acceptance of this application does not create an obligation for APT to hire you. Be advised that your signature on this application confirms that you have read, understand and fully agree to all terms and conditions of employment as set forth in the “Applicant’s Acknowledgement” section of this application.

    Date:____________________ Position applied for:________________________

Name:__________________________________ Social Security:________________

    Drivers License No./Exp Date/State of issue:________________________________

Address:______________________________________________________________

     Street No. City County State Zip

Home Phone:_________________________ Cell Phone:______________________

If less than 5 years at the current address, complete the following:

Previous Address:______________________________________________________

     Street No. City County State Zip

    Are you legally entitled to work in the United States? Yes______ No______

Have you ever been convicted of a crime? Yes______ No_________,

If yes, please explain: __________________________________________________

_____________________________________________________________________

_____________________________________________________________________

    Have you ever been terminated from a job for which you were entitled to collect unemployment? Yes_________ No ____________

If yes, please explain: __________________________________________________

_____________________________________________________________________

_____________________________________________________________________

    EDUCATION

     Number of yrs Degree

     Completed

    High School:______________________________________ _________________________

    College: __________________________________________ _________________________

    Post Graduate:____________________________________ _________________________

    Other (Specify):____________________________________ _________________________

    If referred, who referred you? ___________________________________________________

    EMPLOYMENT HISTORY

    1. Company:________________________________________From:______ To:______

    Address:_________________________________________Phone:_________________

    Position:_________________ Supervisor:_________________ Salary:______________

    Reason for leaving:________________________________________________________

    2. Company:________________________________________From:______ To:______

    Address:_________________________________________Phone:_________________

    Position:_________________ Supervisor:_________________ Salary:______________

    Reason for leaving:________________________________________________________

    3. Company:________________________________________From:______ To:______

    Address:_________________________________________Phone:_________________

    Position:_________________ Supervisor:_________________ Salary:______________

    Reason for leaving:________________________________________________________

    4. Company:________________________________________From:______ To:______

    Address:_________________________________________Phone:_________________

    Position:_________________ Supervisor:_________________ Salary:______________

    Reason for leaving:________________________________________________________

    MILITARY SERVICE - UNITED STATES ARMED FORCES ONLY

Draft Service:___________________________ Reserve Service:__________________________

Dates of Duty: From_________________ TO_________________

Branch of Service:_________________________________Highest Rank:____________________

List Service duties and special training:_______________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

    EMERGENCY CONTACT INFORMATION

Name:_____________________________________Relationship:___________________________

Address:___________________________City:________________State:______Zip:____________

Home Number:__________________________Cell Number:_______________________________

    APPLICANT'S ACKNOWLEDGEMENT

It is very important that you read this section carefully and that you fully understand it before

    you sign it. This section affects your legal rights. If you have any questions regarding your

    legal rights, please ask them before you sign this application. If you do not ask, we will assume

    that you fully understood the language set forth below.

I understand that APT maintains a full and/or modified drug free workplace and

    that a policy is available for review upon request. I may be required to submit a

    drug/alcohol test, under-go a post-job offer medical examination, or proficiency

    tests designed to determine my suitability for the job for which I am being

    considered. Additionally from time-to-time, I may be required to take subsequent

    tests during the course of my employment and I consent to such post-job offer and

    post-hiring testing. I understand that, subject to applicable law, APT shall be the

    sole judge of the acceptability of any test results.

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I hereby give my consent to release the results of my blood and/or urinalysis to the person(s)

    or department(s) or the specified agent of my employer, Advanced Power Technologies

    (“APT”) for the purpose of determining the presence of drugs in my body.

By signing this form, I hereby release to APT and/or their Agent’s Medical Review Officer the

    results of the test(s) to which I have consented. I further authorize APT to discuss the results

    with medical personnel collecting the specimen, the testing facility, its directors, officers,

    agents, and employees responsible for administrating the aforementioned test(s) or

    evaluating the results thereof and any of them herein. I also authorize APT to discuss the

    results with its legal advisors and to use the test results as a defense to any legal action to

    which I am a party. I further release any testing facility or any medical personnel who have

    tested me from any liability arising from a release of any and all results, written reports,

    medical records, and data concerning my test(s) to the appropriate Employer officials. I agree

    to have the results released to APT and/or their Agent’s Medical Review Officer.

As a Donor, I freely and voluntarily agree to a urinalysis drug screen and/or blood alcohol

    screen as part of my application or employment and I understand that a refusal to test, a

    positive confirmed drug test or a tampered with or an adulterated specimen may disqualify me

    from employment.

     ________________ Employee

    Signature Print Name

     / /

    Date

12/4/03

    Background Check

    Authorization to Release Records and Information

    This certifies that the information supplied to Advanced Power Technologies (“APT”) was submitted by myself, and all the information is true and correct to the best of my knowledge. I understand that any material misrepresentations will be considered in an employer(s) overall hiring decisions. I also understand that any and all information supplied by previous Employers, its members, agents, servants or employees including but not limited to Employment History, Education (including an authorization to release transcripts), Credit History, Criminal History, Medical and Professional Licensing, Motor Vehicle Record, Residence History, Workers' Compensation Claims and Personal References will be utilized as part of the processing procedures.

    A background check will be conducted to verify the veracity of the information submitted and will be utilized to develop information concerning my character, general reputation, personal characteristics, and mode of living. I hereby authorize any Background Screening Company, an agent of APT, to make a thorough check of my past employment, education and activities. I hereby release from liability any and all persons, companies and corporations supplying that information. I further hereby release and indemnify any Background Screening Company against any liability that may result from making such background check and or investigation.

A copy of this form is as valid as an original.

_______________________________________________

    Applicants Name (Type or Print)

_______________________________________________

    Signature

____________ _______________________________

    Date Signed Social Security Number

__________________________________________________

    Current Address

_____________ ________________________________

    Date of Birth Home Phone Number (Include Area Code)

______________________ __________________________

    Drivers License Number Issuing State

    Fair Credit Reporting Act

APT and it’s Agents follow all regulations set forth in the Fair Credit Reporting Act (FCRA).

The FCRA regulates companies that provide any type of consumer report - not limited to

    reports containing credit information.

The Fair Credit Reporting Act (FCRA) governs the activities of consumer credit reporting

    agencies, as well as the users of the information procured from these agencies. A consumer

    report contains information on a consumer's (job applicant's) character, reputation and other

    personal data. Employers to screen job applicants procure these reports. You can find the

    complete text of the FCRA, 15 U.S.C. 1681 et seq., at the Federal Trade Commission's web

    site (http://www.ftc.gov). You may have additional rights under state law. You may contact a state or local consumer protection agency or a state attorney general to learn those rights.

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