Blackbeard Services Employment Application Form

Blackbeard Services Employment Application Form

Most Recent Job First

UNEMPLOYMENT: ACCOUNT FOR ALL PERIODS OF TIME, THREE MONTHS OR MORE, BETWEEN POSITIONSHELD OR AFTER SCHOOL
From

MonthDayYear
Date
To

MonthDayYear
Date
How Did You Spend This Time?
From

MonthDayYear
Date
To

MonthDayYear
Date
How Did You Spend This Time?

Rows	Name and Address of School	Major Subject	Did you Graduate?	Type of Degree or Diploma?
High School or Prep
College
College or Graduate
Other

Professional Designations:
Designation
Organization Granting Designation
Date Completed

MonthDayYear
Date
Designation
Organization Granting Designation
Date Completed

MonthDayYear
Date
Professional Licenses:
Type of License
State Granting License
License Number
Type of License
State Granting License
License Number
References

YesNo
If yes, please describe:
*Please Note: Other factors will be taken into account such as the nature of the offense, the time that has passed since the conviction, and the type of job being sought. Further, this information will be used only for job-related purposes and only to the extent permitted by applicable law
PLEASE READ CAREFULLY BEFORE SIGNING APPLICATION
I have submitted the attached form to the company for the purpose of obtaining employment. I acknowledge that the use of this form, and my filling it out, does not indicate that any positions are open, nor does it obligate the company to further process my application.

My signature below attests to the fact that the information that I have provided on my application, resume, given verbally, or provided in any other materials, is true and complete to the best of my knowledge and also constitutes authority to verify any and all information submitted in this application. I understand that any misrepresentation or omission of any fact in my application, resume or any other materials, or during interviews, can be justification for the refusal of employment, or, if employed, termination from the Company’s employ.

I also affirm that I have not signed any kind of restrictive document creating any obligation to any former employer that would restrict my acceptance of employment with the Company in the position I am seeking.

I understand that this application is not an employment contract for any specific length of time between the Company and me, and that in the event I am hired, my employment will be “at will” and either the Company or I can terminate my employment with or without notice at any time. Nothing contained in any handbook, manual, policy and the like, distributed by the Company to its employees is intended to or can create an employment contract, an offer of employment or any obligation on the Company’s part. The Company may, at its sole discretion, hold in abeyance or revoke, amend or modify, abridge or change any benefit, policy practice, condition or process affecting its employees.

References: I hereby authorize the company and its agents to make such investigations and inquiries into my employment and educational history and other related matters as may be necessary in arriving at an employment decision. I hereby release employers, schools, and other persons from all liability in responding to inquires connected with my application and I specifically
authorize the release of information by any schools, businesses, individuals, services or other entities listed by me in this form. Furthermore, I authorize the company and its agents to release any reference information to clients who request such information for purposes of evaluating my credentials and qualifications.
Authorization for Background Check
I, Name hereby authorize Black Beard Services to investigate my background and qualifications for purposes of evaluating whether I am qualified for the position for which I am applying. I understand that Black Beard Services will utilize an outside firm or firms to assist it in checking such information, and I specifically authorize such an investigation by information services and outside entities of the company’s choice. I also understand that I may withhold my permission and that in such a case, no investigation will be done, and my application for employment will not be processed further.
Signature

Clear
Date

Please complete this New Hire EEO-1 Data Sheet. It will supply us with information we need for federal reporting obligations. Please be advised that this information will be used and kept confidential, in accordance with applicable laws and regulations. This information will not be used as the basis for any adverse employment decision.
Name

First NameLast Name
Social Security # (last 4 digits)
EEO-1 Self-Identification
We are subject to certain government recordkeeping and reporting requirements for the administration of civil rights laws and regulations. To comply with these laws, we invite you to voluntarily self-identify your race or ethnicity. Submission of this information is voluntary and refusal to provide it will not subject you to any adverse treatment. The information obtained will be kept confidential and separate from personnel files. It may only be used in accordance with the provisions of applicable laws, executive orders, and regulations, including those requiring information to be summarized and reported to the federal government for civil rights enforcement. When reported, data will not identify any specific individual.
Hispanic or Latino: A person of Cuban, Mexican, Puerto Rican, South or Central American, orother Spanish culture or origin, regardless of race.White (Not Hispanic or Latino): A person having origins in any of the original peoples ofEurope, the Middle East, or North Africa.Black or African American (Not Hispanic or Latino): A person having origins in any of theblack racial groups of Africa.Native Hawaiian or Other Pacific Islander (Not Hispanic or Latino): A person having originsin any of the peoples of Hawaii, Guam, Samoa, or other Pacific Islands.Asian (Not Hispanic or Latino): A person having origins in any of the original peoples of theFar East, Southeast Asia, or the Indian Subcontinent, including, for example, Cambodia, China,India, Japan, Korea, Malaysia, Pakistan, the Philippine Islands, Thailand, and Vietnam.American Indian or Alaska Native (Not Hispanic or Latino): A person having origins in anyof the original peoples of North and South America (including Central America), and whomaintain tribal affiliation or community attachment.Two or More Races (Not Hispanic or Latino): All persons who identify with more than one ofthe above races, excluding those who identify themselves as Hispanic or Latino.
MaleFemale
Signature

Clear
Date
If you should have any questions regarding this form, please contact Human Resources.

In conjunction with my potential employment Black Beard Services, LLC, I Name , consent to the release of my Motor Vehicle Records (MVR) to the company and its insurance agent. I understand the company will use these records in connection with matters of motor vehicle or driver safety that may be related to the position for which I am applying. I also consent to the review and evaluation of the MVR I have provided to the company and understand that release of the MVR does not necessarily mean I will be hired for a driving, or any other position. This consent is given in satisfaction of Public Law 18 U.S.C. Section 2721 at seq. "The Driver's Privacy Protection Act (DPPA)", and is intended at constitute "written consent” as required by this Act.
Signature:

Clear
Date:
Driver's License Number:
State:
Date Of Birth

MonthDayYear
Date
Expiration Date:

MonthDayYear
Date
Black Beard Services, LLC WITNESS TO CONSENT FORM:
Signature:

Clear
Date:

ACEPTAMIENTO DEL EMPLEADO
I understand the policy of Black Beard Services, LLC (the "Company") is to maintain a druf and alcohol-free work environment that is safe and productive for all employees and others having business with the Company. To meet these objectives, I have been provided a copy of the Company's Drug and Alcohol Testing Policy and have read, understand, and agree to confirm to all the requirements of the Policy, including the requirements regarding drug and alcohol testing.

With respect to random testing, I understand the Company also hast the right and obligation in its efforts to maintain a drug-free work environment to conduct random drug screening, and I will cooperate in supplying specimens for random and all other testing purposes that may be requested of me.

I understand that if I refuse to cooperate with testing prescribed by the Company policy, the Company's policy on refusal to test will apply.

I understand that compliance with this policy is a condition of employment. I also understand and agree that employees who test positive or who refuse to submit to drug and alcohol testing will be subject to disciplinary action, up to and including termination of employment.
Date:
Employee Signature:

Clear
Print Name

First NameLast Name
Should be Empty:

Blackbeard Services Employment Application Form

Position Information

Desired Pay

PLEASE CHECK YES OR NO TO THE FOLLOWING:

Professional Designations:

Professional Licenses:

References

PLEASE READ CAREFULLY BEFORE SIGNING APPLICATION

Authorization for Background Check

EEO-1 Self-Identification

ACEPTAMIENTO DEL EMPLEADO