DFI Application

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Position Applying For: *
Name: *

First Name Last Name
Phone Number: *

Area Code Phone Number
E-mail Address:
Address: *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Are you over the age of 18? *

Yes No
If no, enter birth date:

Month Day Year
Only U.S. citizens or aliens who have a legal right to work in the U.S. are eligible for employment. Can you, upon employment, submit documentation verifying your legal right to work in the U.S. and your identity? *

Yes No
Have you ever been convicted of a felony *

Yes No
If yes, give dates and explain. A conviction will not necessarily disqualify you from employment:
Upload Resume:

Educational Data
High School:
Years Completed:
Address:
College:
Years Completed:
Address:
Major Course of Study:
Graduate School:
Years Completed:
Address:
Major Course of Study:
Trade, Business, Night or Course School:
Years Completed:
Address:
Major Course of Study:
Other skills: List any other job-related skills or qualifications that support your application. *
Honors received:
In order to permit a check of your work and educational records, should we be made aware of any change of name or assumed name you have previously used? *

Yes No
If yes, give names and relevant dates:
Have you had prior educational experience which relates to the job you are applying for? *

Yes No
If yes, describe:

References

Please list three (3) references that are familiar with your work life (not related, whom you have known at least one year).
Reference 1
Name: *

First Name Last Name
Phone Number *

Area Code Phone Number
Years Known: *
Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
Reference 2
Name: *

First Name Last Name
Phone Number *

Area Code Phone Number
Years Known: *
Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
Reference 3
Name: *

First Name Last Name
Phone Number *

Area Code Phone Number
Years Known: *
Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code

Additional Remarks

List below any other remarks you wish for us to consider as part of your application for employment.
Have you filed an application here before? *

Yes No
If yes, please provide date:
Are you a veteran of the U.S. Military? *

Yes No
If yes, please list branch and service dates:
Notice to applicants:

This employer complies with the Americans with Disabilities Act of 1990. During the interview process, you may be asked questions concerning your ability to perform job-related functions. If you are given a conditional offer of employment, you may be required to complete a post-job offer medical history questionnaire and/or undergo a medical examination. If required, all entering employees in the same job category will be subject to the same medical questionnaire and/or examination, and all information will be kept confidential in a separate file.

In Case of Emergency

List below your emergency contact and/or spouse's information.
Name: *

First Name Last Name
Phone Number: *

Area Code Phone Number
Address:

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Place of employment: *
Relationship: *
Name: *

First Name Last Name
Phone Number: *

Area Code Phone Number
Address:

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Place of employment: *
Relationship: *

Applicant's Statement

I certify that the answers given herein are true and complete to the best of my knowledge. I authorize the investigation of all matters contained in this application and hereby give the employer permission to contact schools, previous employers, references, and others, and hereby release the employer from any liability as a result of such contact. I understand that misrepresentations, omissions of facts or incomplete information requested in this application may remove me from further consideration for employment. In addition, if employed, any misrepresentations or omissions of facts called for in this application will be cause for dismissal at any time without any previous notice.

Applicants accepted for employment should clearly understand that while we make every effort to provide steady, continuous work, we have no employment contacts, and we cannot guarantee work of any position. Job tenure can be affected by many factors, including business/economic conditions, changes in laws or employee policies, conformity to our work rules, job performance, etc. Any employee may elect to leave on their own accord to seek other jobs.

I understand that my employment with the employer is for no specific term and may be terminated by me or the employer with or without cause at any time. I further understand that no oral promise, employer policy, custom, business practice or other procedure (including the employer's personnel handbook or any personnel manuals) constitutes an employment contract or modification of the at-will employment relationship between me and the employer.

The contents of any employee handbook or personnel manuals, as well as other employer policies, are subject to change or modification by the employer, solely at its discretion, without notice. I also understand that no supervisor or other official of the employer (except its Chief Executive Officer, in writing) has the authority to enter into any agreement with me or to make any agreement contrary to the foregoing.

We conduct our business with the highest possible degree of safety and efficiency, because of this, the employer may require applicants for employment to undergo alcohol and drug screening as part of our pre-placement physical examination.

This application will remain for ninety (90) days. Any applicant wishing to be considered for employment beyond ninety (90) days should reapply.

I agree in advance if there is a workman's compensation or health claim, I the undersigned agree to an illegal substance and alcohol testing. I understand that if I test positive, my benefits, if any, will be severely cut or none at all.
Date:

Month Day Year
Signature

Clear
This employer is an equal opportunity employer. We adhere to a policy of making employment decisions without regard to race, color, age, sex, religion, national origin, handicap or marital status. We assure you that your opportunity for employment with this employer depends solely upon your qualifications.

Background Screening Authorization and Release

In connection with my application for employment with Facciobene Industries, LLC., I authorize certain investigative consumer report(s) to be obtained by BSI-Background Screening & Investigations. These reports may include information as to my character, work habits, performance and experience, reasons for termination of past employment from previous employers, credit information, criminal history information, worker's compensation claims history, and motor vehicle operation history from various state agencies, private and insurance sources, along with other Federal, State and local governmental agencies, and public records available. All measures will be taken to protect the aforementioned information against unauthorized disclosure to any parties not having a legitimate need for it in the discharge of official business. All parties will act in good faith to comply with the Fair Credit Reporting Act (FCRA) and the Drivers Privacy Protection Act (DPPA). Workers compensation information will be requested in compliance with the Americans with Disabilities Act (ADA).

I further acknowledge that a telephone facsimile (FAX) or photocopy of this release shall be as valid as the original. This release includes all state and federal agencies. According to the Fair Credit Reporting Act (FCRA), I am entitled to know if employment is denied because of information obtained by my prospective employer from a consumer-reporting agency. If so, I will be advised and be given the name of the agency and source of information.

BY COMPLETING AND SIGNING THIS RELEASE FORM, I DO HEREBY AUTHORIZE WITHOUT RESERVATION THE AFOREMENTIONED BACKGROUND INVESTIGATION. I ALSO ACKNOWLEDGE THAT SHOULD I BECOME EMPLOYED BY FACCIOBENE INDUSTRIES LLC AND RESIGN WITHIN THIRTY (30) DAYS OF SAID EMPLOYMENT, I WILL BE CHARGED AND HELD LIABLE FOR ALL COST ASSOCIATED WITH THIS BACKGROUND INVESTIGATION, AND I HEREBY AUTHORIZE SAID COST BE DEDUCTED FROM MY FINAL PAY.

I have read and do fully understand the statements contained herein.
Date:

Month Day Year
Signature

Clear
This release shall be valid for one (1) year from the date signed below. You must complete all information requested.
Applicant's Full Name: *

First and Middle Name Last Name
Maiden Name or Previous Married Name:
Address information must cover the last seven (7) years.
Current Address: *

Street Address

City, State, Zip

Dates: From To
Previous Address:

Street Address

City, State, Zip

Dates: From To
Previous Address:

Street Address

City, State, Zip

Dates: From To
SSN:
Date of Birth: *

Month Day Year
Driver's License Number:
Driver's License State:
Previous Driver's License Number and State (if applicable):
Previous Driver's License Dates (if applicable):
The information I have provided above is true and correct.
Date:

Month Day Year
Signature

Clear
Upload Government Issued Photo Identification:

Upload a File

Cancel of
Upload Social Security Card:

Upload a File

Cancel of
NOTE: If you are unable to upload an image of your government issued photo identification, please visit the office. A copy is required to initiate the background investigation.
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