APPLICATION FOR EMPLOYMENT

WE ARE AN EQUAL OPPORTUNITY EMPLOYER

Texas Diligent Staffing evaluates all applicants for employment based on their qualifications and abilities, without discrimination on the grounds of age, race, religious creed, color, national origin, ancestry, physical or mental disability, medical condition, marital status, sexual orientation, sex, or any other status protected by the Texas Commission on Human Rights Act, Texas Labor Code, and applicable federal, state, and local laws. Employment with Texas Diligent Staffing is at-will and may be terminated by either party at any time, with or without cause or notice.

Email*

example@example.com

Name*

First NameMiddle NameLast Name

Phone Number*

Please enter a valid phone number.

Secondary Phone Number

Please enter a valid phone number.

Date of Application*

Date

Social Security Number

SSN

Address*

Street Address

Street Address Line 2

CityState

Zip Code

Birthday*

Date

Gender*

MaleFemaleRather not sayOther

Photo of your ID card*

Make sure that the characters in the photo are clear and recognizable. Supported formats: JPG and PNG. Maximum file size: 2 MB

Are you are under 18 years of age?*

YESNO

Can you lift 50 lb. continuously?*

YESNO

Are you currently employed?*

YESNO

If yes, When are you available to work*

Date

Any type of disabilities?

YESNO

If yes, explain*

Are you prevented from lawfully becoming employed in this country because of Visa or Immigration Status? Proof of citizenship or immigration status will be required upon request.*

YESNO

Are you willing to travel if a job requires it?

YESNO

Have you been convicted of a felony within the last 7 years? A conviction will not necessarily disqualify an applicant from employment.*

YESNO

Are you available to work?*

Full TimePart TimeSwing ShiftTemporary

In your own words, please describe any specialized training, apprenticeship, or skills.*

Be the most detailed as possible, since this will significantly increase the chances of placing you in a position best fitted to your experience.

Indicate all languages you are able to speak, read and/or write*

Start with your present or last job. Fill out a complete section for the last/present job. Include any job-related military service assignments and volunteer activities.

Employer & Address*

Street Address

Street Address Line 2

CityState

Zip Code

Name of immediate supervisor*

First NameLast Name

Supervisor phone number*

Please enter a valid phone number.

Work Performed*

Dates Employed:
From Date* to Date*

Wage / Salary:
Starting Initial: * Final: *

What is your best guess as to how this supervisor would rate your overall performance?*

1 is Worst, 5 is Best

What did you like most about your job?*

What do you like least about your job?*

Reason for Leaving

Terms and Conditions of Employment with Texas Diligent Staffing

1. Employer of Record

I acknowledge that my employer of record for my initial job assignment and any subsequent assignments is Texas Diligent Staffing. The applicable terms and conditions of this original job application apply to both my initial and any future assignments unless changed and/or modified by Texas Diligent Staffing in writing. If any provision of this job application is deemed unenforceable, such determination will not affect the validity of any other provisions, and the unenforceable provision will be adjusted to reflect the intent of the original provision to the greatest extent allowed by law.

2. At-Will Employment and Termination

I understand that my employment with Texas Diligent Staffing is "at-will," meaning it can be terminated at any time, with or without cause, and with or without notice, either by me or Texas Diligent Staffing, in accordance with Texas law. I acknowledge that job abandonment, with or without notice, may lead to immediate termination. To be eligible for temporary job assignments, I must register my availability for work daily with Texas Diligent Staffing. Failure to register may affect my eligibility for unemployment compensation, in line with Texas Workforce Commission guidelines. I understand that my employment terminates at the end of each workday unless I am informed otherwise.

3. Safety

As an employee of Texas Diligent Staffing, I agree to wear and use all safety equipment provided by the company, its customers, or equipment I own for any job assignment. I understand that failure to comply with safety regulations may result in suspension or termination of my employment. If I believe any job assignment is unsafe, I am required to immediately report this to my supervisor and Texas Diligent Staffing. In the event of a work-related injury or illness, I must report it immediately to my direct supervisor and Texas Diligent Staffing in order to receive medical attention through the designated Workers' Compensation network.

I understand that Texas law governs Workers’ Compensation, and I agree to look solely to Texas Diligent Staffing’s Workers' Compensation coverage in case of injury or illness during a job assignment. By signing this agreement, I waive and release any claims against Texas Diligent Staffing’s customers regarding injuries sustained while on assignment. I am not waiving any claims under Texas Diligent Staffing's Workers' Compensation policy.

4. Drug Testing

As an employee of Texas Diligent Staffing, I consent to drug and alcohol testing when required for any job assignment, in compliance with Texas Health & Safety Code. I agree that the results of such tests may be shared with Texas Diligent Staffing and its customers, provided that such sharing complies with applicable privacy laws. A positive drug test or refusal to submit to testing may result in the termination of my employment at the sole discretion of Texas Diligent Staffing.

5. Workplace Conduct

I understand that I am expected to maintain professional behavior at all times while on a job assignment with Texas Diligent Staffing. This includes showing respect to co-workers, supervisors, and customers. I am aware that misconduct, including but not limited to profanity, harassment, theft, or tardiness, may result in disciplinary action, up to and including termination, as per Texas law and Texas Diligent Staffing policies.

6. Benefits

I understand that my employment with Texas Diligent Staffing does not include fringe benefits, including health insurance, paid time off, or retirement benefits, unless otherwise provided for in writing.

7. Dispute Resolution

Texas Diligent Staffing and I agree that any dispute arising out of or relating to this Employment Agreement, including termination, breaches of contract, or violations of rights under federal, state, or local law, shall be resolved by binding arbitration, as governed by the Federal Arbitration Act. Arbitration will be conducted by the American Arbitration Association in accordance with its Employment Arbitration Rules. If arbitration is found to be unenforceable, both parties agree to resolve any disputes through a bench trial (trial by judge) rather than a jury trial, as permitted under Texas law.

8. Representative Actions

I understand that I may only be represented by others in legal actions against Texas Diligent Staffing if I provide written consent. Similarly, I agree not to represent others in legal claims without obtaining their written permission. This clause is subject to Texas Labor Code and relevant federal laws regarding collective or class action suits.

9. Filing Claims

Any claims arising out of or related to this Employment Agreement, including but not limited to breaches or alleged violations of rights, must be filed with the appropriate authorities within thirty (30) days from the date of the incident, in compliance with applicable Texas law.

10. Transportation

I agree that it is my sole responsibility to arrange transportation, whether public or private, to my assigned job location. Texas Diligent Staffing will not be responsible for any commuting expenses.

11. Release of Employment Records

By signing this agreement, I authorize Texas Diligent Staffing to maintain and release certain records related to my employment, including this application, I-9 forms, and drug test results, to third parties such as Texas Diligent Staffing's customers, in accordance with applicable privacy laws. Additionally, I authorize Texas Diligent Staffing to contact my current and previous employers to verify employment history, wages, and performance, as per the Texas Workforce Commission's guidelines.

Initials*

I agree to release and indemnify and release Diligent Staffing Inc, it’s officers and employees harmless for any penalties, fines, and work related injuries during my employment with Diligent Staffing Inc*

First NameLast Name

Signature of Applicant*

Applicant's Statement

I certify that the information provided in this application is true and complete to the best of my knowledge. I understand that any falsification, misrepresentation, or omission of information may result in the rejection of my application or, if employed, dismissal from employment.

I authorize the investigation of all statements made in this application as may be necessary to reach an employment decision. I release the company and any investigative agencies or individuals from any liability for seeking or providing such information.

This application will remain active for consideration for a period of 45 days. If I wish to be considered for employment beyond this period, I understand that I must inquire with the company about the status of current applications or reapply.

I understand and acknowledge that, unless otherwise defined by applicable law, my employment relationship with this organization is “at-will.” This means that I may resign at any time, and the company may terminate my employment at any time, with or without cause or notice. I also understand that no written document, oral statement, or company policy can alter the "at-will" employment relationship unless expressly agreed to in writing by an authorized executive of this organization.

In the event of employment, I agree to comply with all company rules, policies, and procedures. I further understand that false or misleading information provided in this application or during the interview process may result in termination of employment, regardless of when such information is discovered.

I understand, also, that I am required to abide by all rules and regulations of the employer.*

First NameLast Name

Signature of Applicant*

STATEMENT AND ACKNOWLEDGEMENT OF AT-WILL EMPLOYMENT

As an employee of Texas Diligent Staffing, Inc., your employment is and continues to be “at-will.” This means that during the course of your employment with the Company, you are free to terminate your employment at any time, with or without cause or notice, and Texas Diligent Staffing, Inc. has the right to terminate your employment at any time, with or without cause or notice. Although the Company may choose to terminate an employee for cause, cause is not required for termination.

No individual other than the President of the Company has the authority to modify this at-will employment relationship, to enter into an agreement for a specified period of employment, or to make any agreement that contradicts this at-will arrangement. Any such agreement must be in writing and signed by the President of Texas Diligent Staffing, Inc.

By signing below, you acknowledge that you have received a copy of the Company’s Statement and Acknowledgement of At-Will Employment. You confirm that you have read and understood the contents of the Statement and that this Statement supersedes any prior agreements, policies, practices, or guidelines, whether oral or written, regarding the terms of your employment.

Applicant Name*

First NameLast Name

Signature of Applicant*

Note to Employee: The original of this form will go into your personnel file.

EMERGENCY CONTACT INFORMATION

Please complete the following information to ensure we maintain a current record of contact information for you and your emergency contacts.

Emergency Contact Information

Contact Name

First NameLast Name

Contact Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Contact Primary Phone

Please enter a valid phone number.

Contact Alternate Phone

Please enter a valid phone number.

Relationship

APPLICATION FOR EMPLOYMENT

WE ARE AN EQUAL OPPORTUNITY EMPLOYER

APPLICANT CONTACT INFORMATION

APPLICANT BACKGROUND

Employment Experience

1. Employer of Record

2. At-Will Employment and Termination

3. Safety

4. Drug Testing

5. Workplace Conduct

6. Benefits

7. Dispute Resolution

8. Representative Actions

9. Filing Claims

10. Transportation

11. Release of Employment Records

Applicant's Statement

STATEMENT AND ACKNOWLEDGEMENT OF AT-WILL EMPLOYMENT

EMERGENCY CONTACT INFORMATION

Emergency Contact Information