APPLICATION FOR EMPLOYMENT

Classic Services

8601 Six Forks Road Suite 400, Raleigh, NC 27615

Agency Phone: (800)220-7101

Agency Fax: (919) 882-2134

Date

Name

Social Security #

Street

City

State

Zip

Are you over the age of 18 and legally authorized for employment in the US?

Yes No

Phone

Employment desired

Full time Part time Temp Seasonal

Position

Date you can start

Date

Desired Salary (per hour)

Are you employed now?

If so, may we inquire of your present employer?

Yes No

Ever applied for this company before?

Yes No

Where

When

Do you have a valid driver's license as well as reliable transportation to/from work?

Yes No

How far are you willing to travel to job location/site?

15 miles 30 miles open to all travel no travel

Will you work overtime if the position requires it?

Yes No.

Have you ever been terminated or asked to resign from a job?

Yes No

Have you ever been involved in an OSHA reportable accident or illness?

Yes No

Driver's license number

State

Have you been convicted of a felony in the last 7 years? Answering "yes" does not automatically disqualify you as a candidate. If so please detail below.

We conduct reference checks on all canidates who are advanced to the next step of our hiring process. Please provide us with two persons for whom you have worked and are not related to.

Reference 1: Name

Business/Associated Company

Phone

Years Acquainted

Name

Business/Associated Company

Phone

Years Acquainted

Conditions of Employment - please read carefully Reporting to work with impaired abilities; or the possession, consumption or distribution of drugs or alcohol on company premises and/or worksites, shall be grounds for disciplinary action, including discharge. A condition of employment includes willingness on the part of the applicant or employee to agree to physical examination, polygraph and/or substance testing, if required by the company. We are committed to operating a drug free workplace. Violations of our drug and alcohol policy will result in dismissal.

I have read and understood the policy above

I agree

It is understood and agreed upon that any misrepresentation by me in this application will be sufficient cause for cancellation of this application and/or separation from the employer's service if I have been employed. Furthermore, I understand that just as I am free to resign anytime, the Employer reserves the right to terminate my employment at any time, with or without cause and without prior notice. I understand that no representative of the Employer has the authority to make any assurances to the contrary.

I have read and understood the policy above

I agree

I give the employer the right to investigate all police, driving, and personal records and references, if job related. I hereby release from liability the Employer and its representatives for seeking such information and all other persons, corporations or organizations for furnishing such information.

I have read and understood the policy above

I agree

The Employer is an Equal Opportunity Employer. The Employer does not discriminate in employment and no question on this application is used for the purpose of limiting or excusing any applicant's consideration for employment on a basis prohibited by local, State or Federal law.

Any controversy of any kind arising between the parties under this agreement or otherwise (or any agent, officer, director or affiliate of any party), including but not limited to common law, statutory, tort or contract claims, will be submitted to mediation and failing settlement in mediation, to binding arbitration. Unless otherwise agreeda mediation and arbitration designated by staff professionals will govern any mediation and arbitration. The parties will select the mediator or arbitrator from the designated company panel of mediators and will notify the designated company, in writing, to initiate the selection process. The arbitration will be subject to and governed by the provisions of the Federal Arbitration Act. 9 U.S.C. Section 1-et seq. The parties hereto stipulate that this agreement involves matters affecting interstate commerce.

I have read and understood the policy above.

I agree

Signature of Applicant

Clear

Date

AGENCY MANAGEMENT NOTES