METCO - Technician Physical

Technician Physical Requirements
Name

First NameLast Name
Please indicate if employee's dominant hand is:*

RightLeft
I have thoroughly read the summary regarding the position.*
Please Select
I have no preexisting conditions that would prevent me from performing any of the duties requested of me according to the summary.*
Please Select
Applicant Signature*

Clear
Date*

References
Reference 1*

First NameLast Name
Phone*

Area CodePhone Number
Physical or Email Address*
Relationship*
Reference 2*

First NameLast Name
Phone*

Area CodePhone Number
Physical or Email Address*
Relationship*
Reference 3*

First NameLast Name
Phone *

Country CodeArea CodePhone Number
Physical or Email Address *
Relationship *

Authorization and Notification of Rights and Responsibilities

Please read carefully and acknowledge each statement
I hereby certify that I have not knowingly withheld any information that might adversely affect my chances for employment and that the answers given by me are true and correct to the best of my knowledge. I further certify that I, the undersigned applicant, have personally completed this application. I understand that any omission or misstatement of material fact on this application or on any document used to secure employment shall be grounds for rejection of this application or for immediate discharge if I am employed, regardless of the time elapsed before discovery.*

Yes
I hereby authorize METCO to thoroughly investigate my references, public records, (including records documenting an arrest, indictment, convictions, civil judicial action, tax lien or outstanding judgment) work record, education, and other matters related to my suitability for employment and, further, authorize the references I have listed to disclose to the company any and all letters, reports and other information related to my work records, without giving me prior notice of such disclosure. In addition, I hereby release the company, my former employer and all other persons, corporations, partnerships and associations from any and all claims, demands or liabilities arising out of or in any way related to such investigation or disclosure.*

Yes
I understand that nothing contained in the application, or conveyed during any interview which may be granted or during my employment, if hired, is intended to create an employment contract between me and the Company. In addition, I understand and agree that if I am employed, my employment is for no definite or determinable period and may be terminated at any time, with or without prior notice, at the option of either myself or the Company, and that no promises or representations contrary to the foregoing are binding on the company unless made in writing and signed by the CEO and/or the Company’s President.*

Yes
As a condition for my application being considered, I understand and agree to undergo a drug and/or alcohol test. I understand that if my results are positive, I shall not be considered further by Midwest Engineering and Testing Corporation (METCO) for employment. I hereby authorize any medical professional to conduct such testing and to provide the results to Midwest Engineering and Testing Corporation (METCO). I release Midwest Engineering and Testing Corporation (METCO) and the person and organization conducting the testing from liability therefore.*

Yes
Signature*

Clear
Date

MonthDayYear
Date

Driving Record and Background Information
Name*

First NameMiddle NameLast Name
METCO Location Applied to:*
Please Select
Position Applying for:*
Previous Aliases*
Driver's License Type*

Oklahoma REAL IDOut-of-state REAL IDNon-REAL ID License
I understand that I must obtain an Oklahoma REAL ID within the first 30 days of employment.*

Yes
Driver's License Number*
State*
Date of Birth*
Expiration Date*
Current Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Starting Month and Year of Occupancy:*
Additional addresses needed?*

YesNo

Notice:

As required by the Federal Driver Privacy Protection Act (DPPA), 18 U.S.C. Section 2721, the Oklahoma Department of Public Safety/Motor License Agent will not release personal information from your driver record unless you consent by waiving your right to privacy under the DPPA; OR, unless the Department is required by DPPA to release personal information without your consent, such as in connection with matters of safety, theft, emissions, product alterations, recalls, advisories, certain federal laws; or, unless the DPPA authorizes the Department to release it, such as to governmental entities, courts, insurance companies and to others specified.

I voluntarily give consent to the Oklahoma Department of Public Safety or any Motor License Agent to release my driver record(s), as indicated by my electronic signature below, to be released to the following person, company, corporation or legal entity:

Midwest Engineering and Testing Corporation
225 S Nicklas Avenue
Oklahoma City, OK 73128
P. (405) 681-6737
Date

MonthDayYear
Date
Signature

Clear

I acknowledge receipt of the Disclosure Regarding Background Investigation and certify that I have read and understand the document. I hereby authorize the obtaining of “consumer reports” and/or “investigative consumer reports” at any time after receipt of this authorization and, if I am hired, throughout my employment.
I have read and understood this disclosure*

Yes

Disclosure Regarding Background Investigation:

METCO may obtain information about you from a consumer reporting agency for employment purposes. Thus, you may be the subject of a “consumer report” and/or an “investigative consumer report” which may include information about your character, general reputation, personal characteristics, and/or mode of living, and can involve personal interviews with sources such as your neighbors, friends or associates. These reports include checks regarding your criminal history, professional licenses, workers’ compensation insurance claims and credentials. You have the right upon written request made within a reasonable time after receipt of this notice, to request disclosure of the nature and scope of any investigative consumer report.

Please be advised that the nature and scope of the most common form of investigative consumer report obtained with regard to applicants for employment is an investigation into your education and/or employment history conducted by VICTIG, 14587 South, 790 West, Suite C 201, Bluffdale, UT 84065 Phone: 866-886-5644, Fax: 866-721-8263, or another outside organization. Your below signature is an acknowledgement that an employer may obtain from any outside organization all manner of consumer reports and investigative consumer reports now and, if you are hired, throughout the course of your employment to the extent permitted by law.
I authorize a consumer report*

Yes
Please check this box if you would like to receive a copy of a consumer report if one is obtained by the company. *

YesNo
Date/Time*
Signature*

Clear
Should be Empty:

Technician Physical Requirements

Employment Application

Education

Employment

References

Authorization and Notification of Rights and Responsibilities

Driving Record and Background Information