APPLICATION FOR EMPLOYMENT

List your 3 most recent positions held, starting with the most recent employer first.

I certify that the information contained in this application is true, complete, and accurate.  I understand that, if employed, false statements or omissions on this application may result in rejection of my application or discharge at any time during my employment.

I authorize investigation of all statements contained herein.  I further authorize all individuals, companies, schools, corporations, courts, and law enforcements agencies to give you any and all information concerning my previous employment and any pertinent information they may have, personal or otherwise.  I release all parties from all liability for damage that may result from divulging or using information.

I understand and agree that, if hired, my employment is for no definite period and either I or the company can terminate the employment relationship at any time, with or without cause, and with or without notice.  This employment relationship exists regardless of any other statements or policies to the contrary.

I realize that under certain provisions of Nebraska law, I may be required to submit to a post offer pre-employment physical (which will include a drug test) as a condition of my employment.  I hereby agree to submit to such an examination if required so by company policy and permit disclosure of the results to the company.

This company does not unlawfully discriminate in hiring or any aspect of the employment relationship on the basis of age, race, color, sex, religion, national origin, disability, or any other basis protected by law in the jurisdiction in which the employment is performed.  

AN EQUAL EMPLOYMENT

OPPORTUNITY EMPLOYER

In connection with my ongoing employment or my application for employment, should I have or secure a position with  Contractor Services, Inc, I understand that a motor vehicle record, which contains public record information, may be requested. I further understand that such report(s) will contain personal information and public record information concerning my driving record from federal, state, and other agencies that maintain such records, as well as independent services that provide driving record information.

I authorize, without reservation, any party or agency contacted to furnish the above-mentioned information to UNICO Group, Inc. or its agent.

I hereby authorize procurement of my motor vehicle report.  If hired, this authorization shall remain on file and shall serve as ongoing authorization for you to procure such reports at any time during my employment. Contractor Services, Inc’s commercial auto insurer and agent will also use this information in conjunction with loss control and safety review efforts.

It is the policy of Contractor Services, Inc., to assure that applicants are employed, and that employees are treated during employment without regard to their race, religion, sex, creed, color, national origin or age or disability.

The information requested below is NOT REQUIRED BUT NEEDED to help the company implement its Affirmative Action Program and provide information required by the City, State, and Federal Employment Opportunity Agencies.