Preferred Phone Number
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Position applied for:
Education
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Elementary School Middle School High School College/University Technical School Employment History
Please give the following information for all present and previous employers, beginning with the most recent.
Employer 1
Address
Employer 2
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Employer 3
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References
Please list three individual references from people who are familiar with your work, skills, ability, and character.
Background
Have you ever been charged with a crime or received a verdict of anything other than Not Guilty in any criminal investigation or proceeding? Yes No
Confirmations
I certify that answers given herein are true and complete to the best of my knowledge. I authorize investigation of all statements contained in this application for employment as may be necessary in arriving at an employment decision. I further understand that any information reported by me on this application that is false will be reason for immediate disqualification for consideration for employment.
I accept the above.
UNDER MARYLAND LAW, AN EMPLOYER MAY NOT REQUIRE OR DEMAND, AS A CONDITION OF EMPLOYMENT, PROSPECTIVE EMPLOYMENT, OR CONTINUED EMPLOYMENT, THAT AN INDIVIDUAL SUBMIT TO OR TAKE A LIE DETECTOR OR SIMILAR TEST. AN EMPLOYER WHO VIOLATES THIS LAW IS GUILTY OF A MISDEMEANOR AND SUBJECT TO A FINE NOT EXCEEDING $100.
I accept the above
I understand that nothing contained in this application is intended to create an employment contract between the George J. Falter Company, Inc. and myself for either employment or the providing of any benefit. No promises of any kind regarding employment with the George J. Falter Company, Inc. have been made to me. If an employment relationship is established, I understand that my employment will be at-will and that I or the George J. Falter Company, Inc. have the right to terminate my employment at any time for any reason, with or without cause. Further, I understand that no officer, agent, representative, or employee of the George J. Falter Company, Inc. has any authority to enter into any agreement for employment for any specified period of time or to make any agreement for specific wages, benefits, or other conditions of employment, unless such agreement is committed to in writing and signed by the president of the George J. Falter Company, Inc. Finally, I understand that any representations made by officers, agents or employees of the George J. Falter Company, Inc. during the interview process are only their own personal expectation of the requirements and conditions of employment should I be hired and it is entirely possible that the actual requirements and conditions of employment will be entirely different and contrary to any representations made to me.
I accept the above
Authorization for Release of Information
I hereby authorize the George J. Falter Company, Inc. (hereafter "the Company" or "Employer"), its employees, agents, private investigators or any representative of the aforesaid company, to perform investigations into my background, past behavior, to my character, general reputation, and mode of living. In addition, I further authorize investigations of the following:
Education: I authorize schools, colleges and all scholastic institutions to release any and all information requested. This includes transcripts, grades, attendance records, and any other information requested.
Employment: I authorize all former and current employers to release any and all information regarding my employment history. This includes all information contained in my personnel file, salary history, condemnations, and all other pertinent information. I further authorize my supervisors and other work associates to disclose their opinions and observations of my work habits, qualities, competency, and skills. Furthermore, I authorize full disclosure of any and all drug and alcohol testing results.
Authorization to Release: I authorize custodians of the records of any agency, government agency, or company as described above to release such information upon request of any investigator, agent, or representative of the Company. I understand that any or all of these investigations or inquiries can be performed prior to and periodically throughout the duration of my employment.
Re-disclosure: I understand that the information requested is for the use by the Company and may be re-disclosed only as authorized by law. I understand that I have the right to request from the Company a written disclosure of the nature and scope of the investigation conducted that I authorized above.
Indemnification: I indemnify, release, and hold harmless the Company, any agents of the Company, or others reporting to or for the Company, any investigators, all former employers, reporting agencies, and all those supplying references and character references, from any and all claims, defamation, demands, and/or liabilities arising out of, or related to, such investigations, disclosures, or admissions.
Signature: Copies and facsimile transmissions of this authorization that show my signature are as valid as the original release signed by me.
By checking this box I authorize the above Other last names used
Other states and counties that you have lived:
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