Work Eligiblity
TP#:
Have you ever worked for, or been affiliated with, a company that is involved in pending litigation or has had entered against it an injunction, a temporary restraining order, or a final judgment or order, including a stipulated judgment or order, an assurance of voluntary compliance, or any similar document, in any civil or administrative action involving racketeering, fraud, theft, embezzlement, fraudulent conversion, or misappropriation of property or the use of any untrue, deceptive, or misleading representation or the use of any unfair, unlawful, or deceptive trade practice?
Yes No
Have you, regardless of adjudication, previously been convicted or found guilty of, entered a plea of guilty or a plea of nolo contendere to, or are you under indictment or information for, racketeering or any offense involving fraud, theft, embezzlement, fraudulent conversion, or misappropriation of property?
Yes No
Have you, regardless of adjudication, previously been arrested for, convicted or found guilty of, entered a plea of guilty or a plea of nolo contendere to, or are you under indictment or information for a felony?
Yes No
Authorization
I certify that the facts contained in this application are true and complete to the best of my knowledge and understand that any falsified statements on this application may be grounds for the termination of any and all contracts and/or agreements made with the company.
I authorize an investigation of all statements contained herein. The references and previous work history contacts listed are authorized to give you any and all information concerning my relationship with them, and release the company from all liability or any damage that may result from the utilization of such information. I therefore authorize the company to complete a background check in order to investigate these statements and all application information.
I also understand and agree that no representative of the company has any authority to enter into any agreement contrary to the foregoing, unless it is in writing and signed by an authorized company representative.
You hereby consent and agree that your use of a key pad, mouse or other device to select an item, button, icon or similar act/action while using any electronic
service we offer; or in accessing or making any transactions regarding any agreement, acknowledgment, consent, terms, disclosures or conditions constitutes
your signature, acceptance and agreement as if actually signed by you in writing.