• Application For Employment

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  • Personal Information

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  • Emergency Contact Information

  • CURRENT & PREVIOUS EMPLOYERS:

    List most recent position first.
  • Employer 1:

  • Employer 2:

  • Employer 3:

  • Employer 4:

  • Employer 5:

  • EDUCATION

  • PERSONAL REFERENCES

    Provide three individuals, not related to you, whom you have known for at least two years.
  • Reference 1

  • Reference 2

  • Reference 3

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  • Please read the following statement carefully before signing.

    I certify that the information I have provided, contained in this application is true and completer to the best of my knowledge and I understand that, if employed, falsified statements on this application may result in termination of employment with Media Reload.

    I understand and agree that, if hired, my employment at Media Reload is at-will and for no definite period, may, regardless of the date of payment of my wages and salary, be terminated with or without cause, at any time, with or without notice.
    I authorize Media Reload to obtain documents regarding my background and previous employment and to investigate my history including all statements contained in this application for any employment-related purposes. I authorize all references and all employers to provide Media Reload with any application information they may possess. I release these references and former employers from all liability for any information they may provide to Media Reload.

  • Clear
  • LIABILITY RELEASE

    As an applicant for employment with Media Reload, I understand that a thorough background investigation may be conducted to qualify me for eligibility.

    I authorize the custodian of any information related to my previous employment, driving record, education, residence, criminal convictions, credit standing, or character, to release information to Media Reload. This authorization is made voluntarily for the purpose of employment only. I agree to hold harmless any individual or agency involved with the authorized release of legitimate information.

    According to the Fair Credit Reporting Act (Law 91-508) SS603, 604, and 606 as revised October 1997: A person may not procure or cause to be prepared an investigative consumer report on any consumer unless it is clearly and accurately disclosed to the consumer that an investigative consumer report including information as to character, general reputation, personal characteristics, mode of living, and employment history, whichever are applicable, may be made. “I also understand that, if I am denied employment because of the consumer investigation, it is my right to have a copy of said reports(s) released to me within the time allowed through the agency(s) disclosed to me, if I submit a written request to said agency(s) within a reasonable period of time. I further understand that, if I am offered a position, this is a conditional offer pending the outcome of the consumer investigation. If the institution is required to conduct interviews with former employers or acquaintances of mine, the institution must notify me of the inquiry or notify me within three days of the request.”

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  • This form should be attached to every application and mailed or faxed to the former employer(s) or others with information pertinent to the applicant’s eligibility.

  • Should be Empty:
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