G4 SERVICES LLC APPLICATION

INDEPENDENT CONTRACTOR AGREEMENT

All * fields required for submission
Position Applied For*
Example: Welder, Fitter, Rigger, etc.
Preferred Company To Work At
Optional
This agreement is made between G4 Services, LLC, whose address is 117 Citris Court, Thibodaux, LA, 70301, and the independent contractor:
Application
Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Social Security #
Drivers License #
State Issued
Date of Birth*

MonthDayYear
Date
Phone Number*
Please enter a valid phone number.
Email*
example@example.com
Emergency Contact Information
Name*

First NameLast Name
Relationship*
Phone Number*
Please enter a valid phone number.
Background Check Authorization Form
I hereby authorize G4 Services, LLC, and/or any of its officers, employees, or agents to investigate my background, references, character, education, past employment, and/or criminal records in order to confirm my qualifications for employment as represented on my resume and/or application, and/or my employment interview.

By signing below, I release G4 Services, LLC, and/or its officers, employees, or agents, as well as any person or entity providing information on my background pursuant to this acknowledgement form, from any and all liability in relation to the information obtained from any and all referenced sources used.
Do you agree with the above statement?*
Are you eligible to work in the United States?*

YesNo
Have you been convicted of a felony within the last ten years?*

YesNo
I, First Name* Last Name*, hereby agree to reimburse G4 Services, LLC, for any and all expenses incurred during my 90 day probationary period of my work as a subcontractor including, but not limited to, background checks, drug screens, and training classes if I do not work for more than 90 days from the first scheduled work date. I give G4 Services, LLC permission to take any money owed out of my last check (s). If my last check does not cover the amount owed, I agree that I am liable for the remaining payment. Background checks will be reimbursed to G4 Services LLC on first check.
Do you agree with the above statement?*
I certify that information contained in this application is true and complete. I understood that false information may be grounds for not hiring me or immediate termination of employment at any point in the future if I am hired. I authorize the verification of any or all information listed above.
Do you agree with the above statement?*
Name*

First NameLast Name
Signature*

Clear
Date*

MonthDayYear
Should be Empty:

INDEPENDENT CONTRACTOR AGREEMENT

Application

Emergency Contact Information

Background Check Authorization Form