• Application for Employment

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  • Equal access to programs, services and employment is available to all persons. Those applicants requiring reasonable accommodation to the application and/or interview process should notify a representative of the Human Resources Department.

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  • Address

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  • CONVICTION WILL NOI NECESSARILY BE A BAR TO EMPLOYMENT. EACH INSTANCE AND EXPLANATION WILL BE CONSIDERED IN RELATION TO THE POSITION FOR WHICH YOU ARE APPLYING

  • Employment History

    Provide the following information for your past four (4) employers, assignments or volunteer activities, starting with the most recent.
  • AN EQUAL OPPORTUNITY EMPLOYER

  • Skills and Qualifications

  • Educational Background

    IF JOB-RELATED
  • References

  • I UNDERSTAND THAT IF IAM EMPLOYED. ANY MISREPRESENTATION OR MATERIAL OMISSION MADE BY ME ON THIS APPLICATION WILL BE SUFFICIENT CAUSE FOR CANCELLATION OF THIS APPLICATION OR IMMEDIATE DISCHARGE FROM THE EMPLOYER'S SERVICE. WHENEVER IT IS DISCOVERED.

    I GIVE THE EMPLOYER THE RIGHT TO CONTACT AND OBTAIN INFORMATION FROM ALL REFERENCES. EMPLOYERS. EDUCATIONAL INSTITUTIONS AND TO OTHERWISE VERIFY THE ACCURACY OF THE INFORMATION CONTAINED IN THIS APPLICATION, I HEREBY RELEASE FROM LIABILITY THE EMPLOYER AND ITS REPRESENTATIVES FOR SEEKING. GATHERING AND USING SUCH INFORMATION AND ALL OTHER PERSONS, CORPORATIONS OR ORGANIZATIONS FOR FURNISHING SUCH INFORMATION.

    THE EMPLOYER DOES NOT UNLAWFULLY DISCRIMINATE IN EMPLOYMENT AND NO QUESTION ON THIS APPLICATION IS USED FOR THE PURPOSE OF LIMITING OR EXCUSING ANY APPLICANT FROM CONSIDERATION FOR EMPLOYMENT ON A BASIS PROHIBITED BY LOCAL, STATE OR FEDERAL LAW

    THIS APPLICATION IS CURRENT FOR ONLY 60 DAYS. AT THE CONCLUSION OF THIS TIME, IF HAVE NOT HEARD FROM THE EMPLOYER AND STILL WISH TO BE CONSIDERED FOR EMPLOYMENT. IT WILL BE NECESSARY TO FILL OUT A NEW APPLICATION

    IF I AM HIRED,UNDERSTAND THAT I AM FREE TO RESIGN AT ANY TIME, WITH OR WITHOUT CAUSE AND WITHOUT PRIOR NOTICE, AND THE EMPLOYER RESERVES THE SAME RIGHT TO TERMINATE MY EMPLOYMENT AT ANY TIME, WITH OR WITHOUT CAUSE-AND WITHOUT PRIOR NOTICE, EXCEPT AS MAY BE REQUIRED BY LAW. THIS APPLICATION DOES NOT CONSTITUTE AN AGREEMENT QR CONTRACT FOR EMPLOYMENT FOR SPECIFIED PERIOO OR DEFINITE DURATION. I UNDERSTAND THAT NO REPRESENTATIVE OF THE EMPLOYER OTHER THAN AN AUTHORIZED OFFICER, HAS THE AUTHORITY TO MAKF. ANY ASSURANCES TO THE CONTRARY. I FURTHER UNDERSTANO THAT ANY SUCH ASSURANCES IUST BE IN WRITING AND SIGNED BY AN AUTHORIZED OFFICER.

    I UNDERSTAND IT IS THIS COMPANY'S POLICY NOT TO REFUSE TO HIRE A QUALIFIED INDIVIQUAL WITH A DISABILITY BECAUSE OF THAT PERSON'S NEEO FOR A REASONABLE ACCOMMODATION AS REQUIRED BY THE ADA.

    I ALSO UNDERSTAND THAT IF IAM HIRED, I WILL BE REQUIRED TO PROVIDE PROOF OF IDENTITY AND LEGAL WORK AUTHORIZATION.

  • In Case of Emergency Notify

  • I represent and warrant that I have read and fully understand the foregoing and seck employment under these conditions.

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  • You should include this Notice in any application for employment. This Notice should also be posted in an appropriate and conspicuous location on your premises and made available for inspection by the general public during regular business hours in your personnel office. This form should be completed at the time of the employment application.

  • (The Company) has established and maintains a Drug-Free Workplace Program. This Drug-Free Workplace Program is in conformity with chapter 440.102, Florida Statutes, its implementing regulations, and Federal law.

  • As part of this Program, offers of employment are expressly conditioned upon passing a drug test. In addition, employees of the Company may be subject to drug testing under those conditions outlined in the Company's Drug and Alcohol Policy Statement.

    For persons receiving a conditional offer of employment, failure of a drug test or refusal to submit to drug testing when required by the Company shall terminate any job offer. For employees, failing a drug test or refusing to submit to a drug test will result in action against an employee up to and including termination of employment.

    Persons receiving a conditional offer of employment will have an opportunity to confidentially report to the Medical Review Officer (MRO) the use of prescription or non-prescription medications both before and after being tested. Additionally, job applicants shall receive a list of common medications which may alter or affect a drug test. Job applicants will also be given the names, addresses, and telephone numbers of local alcohol and drug rehabilitation programs.

    Any person receiving a conditional offer of employment who fails a drug test may challenge or explain the result within five working days after written notification of the test result. A job applicant will also have an opportunity to request a retest at the job applicant's expense. If a job applicant's explanation or challenge is unsatisfactory, the job applicant may contest the drug test results pursuant to rules adopted by the Department of Labor and Employment Security or the Agency for Health Care Administration. The job applicant also has the responsibility to notify the laboratory or clinic conducting the drug test of any administrative or civil action brought involving the drug test conducted by that laboratory or clinic. The job applicant also has a right to consult the testing laboratory or clinic for technical information regarding prescription and non-prescription medication. In addition, each job applicant will be given a list of the substances to be tested prior to administration of the drug tests. All test results will remain confidential except as allowed by law. The Company will provide all job applicants with a copy of the Company's Drug and Alcohol Abuse Policy Statement prior to administration of a drug test.

    Nothing in this Notice will affect these rights provided in any collective bargaining agreement between the Company and its employees. Refusal to complete or sign this document will result in a withdrawal of any offer of employment.

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  • APPLICANT DRUG-TESTING CONSENT AND RELEASE

  • This form must be completed when employee is given conditional job offer.


    Pursuant to my application for employment, I understand that all job offers are expressly conditioned upon submitting to and passing a drug test to detect the presence of illegal drugs or alcohol use. I hereby consent to submit to a urinalysis or other tests as required by    (the Company) for the purposes of testing for the presence of illegal drugs or alcohol abuse. I agree that a clinic or laboratory approved by the Florida Agency for Health Care Administration may collect and test any specimens I provide for these tests. I further agree to authorize the release of the results of these tests to the Medical Review Officer employed or retained by the Company, to the     of the Company, and to such other management personnel as may require this information on a need to know basis. My understanding is that any information derived from these tests will be confidential between the laboratory, the      of the Company, and the Medical Review Officer, except as otherwise provided by law, or if I place the test or its results in issue in any administrative, legal, or other proceeding.


    I further agree to release and hold the Company and its agents, employees and assigns, including the laboratory collecting and conducting these tests, harmless from any liability arising in whole or in part out of the collection or testing of the specimens I provide or from the use of the information derived from these tests in consideration of my employment application.


    I have carefully read this Consent and Release form and understand it completely. I also understand that execution of this Consent and Release is a condition of employment with the Company and my refusal to sign will result in withdrawal of any offer of employment I may receive. I am signing this form voluntarily and have not been coerced nor placed under duress by any person.


  • Applicant

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  • Witness - 1

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  • Witness - 2

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  • In connection with my application for employment (including contract services), I understand that investigative background inquires are to be made including consumer, criminal, driving, and other reports. These reports will include information as to my character, work habits, performance and experience along with reasons for termination of past employment from previous employers. Further, I understand that you will be requesting information from various Federal, State, and National agencies which maintain records concerning my past activities relating to my driving, credit, criminal, and other experiences as well as claims involving me in the files of insurance companies. I authorize without limitations, this employer to furnish the above mentioned or any other findings associated with the background search to the Hotel Motel Association of Volusia County (Agent for Flair Air Conditioning) to by used by its officers, managers, agents, and assigns.

    These reports are a necessary part of our review of your application and are used to verify or supplement information that you may have already provided us. Examples of the type of consumer reports we may order include: Motor Vehicle Report (MVR), Insurance Claim Report, and/or an Insurance Score based on the National Credit File.

    All reports that are ordered are impartial and will be kept strictly confidential. Our sole interests in the reports are to be sure that each application is evaluated fairly. The information we obtain will only be used for business purposes. If you wish, we will provide you with the name, address, and phone number of any consumer reporting agency from whom we request a report. At your request, the consumer-reporting agency will provide you with a copy of the report.

    IMPORTANT: The Public Records and commercially available data sources used on reports may have errors. Data is sometimes entered poorly, processed incorrectly and is general not free from defect. This system should not be relied upon as definitively accurate. Before relying on any data that this system supplies, it should be independently verified. National Data does NOT include all states in the United States, only those states that have a "Right to Know" policy. Many states are protective of personal data and will not permit release of information. For those states that DO have a "Right to Know" policy, requests list from Rockwood Credit & Background Screening. *For those states that DO NOT include "Right to Know" see the following: Delaware DE, Hawaii HI, Massachusetts MA, North Dakota ND, South Dakota SD, Vermont VT, West Virginia WV, Wyoming WY.

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  • PLEASE PRINT CLEARLY - ALL IS REQUIRED

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  • *MUST HAVE PHOTO COPY OF DRIVERS LICENSE*

  • MEDICAL QUESTIONNAIRE

    HAVE YOU HAD OR DO YOU HAVE ANY OF THE FOLLOWING (Check "Yes" or "No" after each question):
  • Disease of:

  • I authorize investigation of all statements contained in the application and certify that they are correct.

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  • Should be Empty: