Career Opportunities with Drug Screen Compliance

Order Number

Personal Info

First Name *

Middle Name *

Last Name *

Contact Info

Phone *

Mobile Phone

Email Address *

Address

Street *

City *

State *

Zip Code *

Application Info

Position(s) Applied For *

Date of Application *

Office Location *

Did anyone refer you? *

Yes No

Questions Part 1

If necessary, best time to call you at home is? *

May we contact you at work? *

Yes No

Proof of Age

If you are under 18 and it is required, can you furnish a work permit? *

Yes No

Previous Applicant

Have you submitted an application here before? *

Yes No

Previous Employee

Have you ever been employed here before? *

Yes No

Date available for work: *

Type of Employment Desired

Employment Desired

Full-Time

Part-Time

Educational Co-Op

Seasonal

Temporary

Check all that apply.

Are you legally eligible for employment in this country? *

Yes

What is your desired salary range or hourly pay rate?

Salary

Hourly

Will you relocate if job requires it? *

Yes

Questions Part 2

Will you travel if job requires it? *

Yes

Will you work overtime if required?

Yes No

Have you ever been bonded? *

Yes

Are you applying for a driving position? *

Yes No

If they have been explained to you, are you able to meet the attendance requirements of the position? *

Yes

N/A

Answering "yes" to the following question does not constitute an automatic bar to employment. Factors such as date of the offense, seriousness and nature of the violation, rehabilitation and position applied for will be taken into account.

Have you ever pled *

Yes No

Employment History

Starting with your most recent employer, provide the following information.

How many previous employers have you had?

1 2 3

Employer 1

Employer *

Phone *

Street Address *

City *

State *

Job Title *

Dates Employed *

From

Dates Employed *

Compensation (starting)

Pay Type *

Hourly

Salary

Rate *

Commission/Bonus/Other/Compensation *

Compensation (final)

Pay Type *

Hourly

Salary

Rate *

Commission/Bonus/Other/Compensation *

Supervisor Info

Immediate Supervisor and Title (for most recent position held): *

May we contact for reference? *

Yes

Later

Why did you leave? *

Summarize the type of work performed and job responsibilities *

What did you like most about your position? *

What were the things you liked least about the position? *

Employment History Continued

Explain any gaps in your employment, other than those due to personal illness, injury or disability *

If not addressed on previous page, have you ever been fired or asked to resign from a job? *

Yes No

Skills & Qualifications

Summarize any special training, skills, licenses and/or certificates that may assist you in performing the position for which you are applying: *

Any computer skills? *

Yes No

Educational Background

Starting with your most recent school attended, provide the following information.

Did you attend high school? *

Yes No

Did you attend college? *

Yes No

Did you attend another school? *

Yes No

References

List name and telephone number of three business/work references who are not related to you and are not previous supervisors. If not applicable, list three school or personal references who are not related to you.

Reference 1

Name *

Title *

Relationship to you *

Phone *

Number of years known *

Reference 2

Name *

Title *

Relationship to you *

Phone *

Number of years known *

Reference 3

Name *

Title *

Relationship to you *

Phone *

Number of years known *

Reference 4

Name *

Title *

Relationship to you *

Phone *

Number of years known *

Related Information

Exclude information that would reveal race, color, religion, sex, national origin, citizenship, age, mental or physical disabilities, veteran/reserve national guard or any other similarly protected status.

To what job-related organizations (professional, trade, etc.) do you belong?

List special accomplishments, publications, awards, etc.

In your current or a prior job, have you ever written instructions or directions to be followed by employees or customers?

Yes No

Is there any other job-related information you want us to know about you?

Applicant Statement

I certify that all information I have provided in order to apply for and secure work with this employer is true, complete and correct.

I expressly authorize, without reservation, the employer, its representatives, employees or agents to contact and obtain information from all references (personal and professional), employers, public agencies, licensing authorities and educational institutions and to otherwise verify the accuracy of all information provided by me in this application, resume or job interview. I hereby waive any and all rights and claims I may have regarding the employer, its agents, employees or representatives, for seeking, gathering and using truthful and non-defamatory information, in a lawful manner, in the employment process and all persons, corporations or organizations for furnishing such information about me.

I understand that this employer does not unlawfully discriminate in employment and no question on this application is used for the purpose of limiting or eliminating any applicant from consideration for employment on any basis prohibited by applicable local, state or federal law.

I understand that this application remains current for only 30 days. At the conclusion of that time, if I have not heard from the employer and still wish to be considered for employment, it will be necessary for me to reapply and fill out a new application.

If I am hired, I understand that I am free to resign at any time, with or without cause and with or without prior notice, and the employer reserves the same right to terminate my employment at any time, with or without cause and with or without prior notice, except as may be required by law. This application does not constitute an agreement or contract for employment for any specified period or definite duration. I understand that no supervisor or representative of the employer is authorized to make any assurances to the contrary and that no implied oral or written agreements to the contrary to the foregoing express language are valid unless they are in writing and signed by the employer's president.

I also understand that if I am hired, I will be required to provide proof of identity and legal authorization to work in the United States and that federal immigration laws require me to complete an I-9 Form in this regard.

I understand that any information provided by me that is found to be false, incomplete or misrepresented in any respect, will be sufficient cause to (i) eliminate me from further consideration for employment, or (ii) may result in my immediate discharge from the employer's service, whenever it is discovered.

READ APPLICANT STATEMENT & THEN VERIFY

I certify that I have read, fully understand and accept all terms of the foregoing Applicant Statement.

I have read and agree to the application statement *

Yes

Date read *

Authorization Forms

Fill out the following and email both documents to dscsales@drug-screen.com

Applicant Consent Form for Employment Investigation