Eagle Resource Group, Inc. Payroll Deduction Form

PAYROLL DEDUCTION FORM
Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*
Please enter a valid phone number.
E-mail Address:*

Confirmation Emailexample@example.com
I, {name}, understand that Eagle Resource Group, Inc. (ERG) is a drug free workplace and that I will be drug tested prior to being sent on an assignment.

In addition, I understand that Eagle Resource Group, will run a criminal background and credit check and I must be willing to submit to this process in order to be considered for employment.

I authorize ERG to deduct from my first paycheck the amount to cover the cost associated with the pre-employment process.

Thank You
Applicant Signature*

Clear
Draw your signature
Date

MonthDayYear
Date
Hour MinutesAM/PM Option
Please verify that you are human*
Should be Empty: