Employment History
Previous Employer #1
Company Name Dates Employed: Start Date End Date Role/Title Location Reason for Leaving
Previous Employer #2
Company Name Dates Employed: Start Date End Date Role/Title Location Reason for Leaving
Previous Employer #3
Company Name Dates Employed: Start Date End Date Role/Title Location Reason for Leaving
Previous Employer #4
Company Name Dates Employed: Start Date End Date Role/Title Location Reason for Leaving
Contractor Agreement & Consent to Drug and/or Alcohol Testing
I hereby agree, upon request made under the drug/alcohol testing policy of AllStar Security Group LLC B20696 (the company), to submit to a drug or alcohol test and to furnish a sample of my urine, breath, and/or blood for analysis. I understand and agree that if I refuse to submit to a drug or alcohol test under company policy, or if I otherwise fail to cooperate with the testing procedures, I will be subject to immediate termination. I further authorize and give my full permission to have the Company and/or its company physician send specimen or specimens collected to a laboratory for screening test for the presence of any prohibited substances under the policy, and for any government entity involved in a legal proceeding or investigation connected with test. Finally, I authorize the Company to disclose any documentation relating to such test to any governmental entity involved in a legal proceeding or investigation connected with the test.
I understand that only duty-authorized Company officers, employees, and agents will have access to information furnished or obtained in connection with the test; that they will maintain and protect the confidentially of such information to the greatest extent possible; and that they will share such information only to the extent necessary to make employment decisions and to respond to inquiries or notices from governmental entities.
I will hold harmless the Company, its company physician, and any testing laboratory the Company might use, meaning that I will not sue or hold responsible such parties for any alleged harm to me that might result from such testing, including loss of employment or any kind of adverse job action that might arise as a result of the drug or alcohol test, even if Company or laboratory representatives make an error in the administration or analysis of the test or the reporting of the results. I will further hold harmless the Company its physician and any testing laboratory the Company might use for any alleged harm to me that might result from the release or use of information or documentation relating ot the drug or alcohol test, as long as the release or use of the information is within the scope of this policy and procedures as explained in the paragraph above.
The policy and the authorization have been explained to me in a language I understand and I have been told that if I have any questions about the test or the policy, they will be answered.
I understand that the company will require a drug screen test under this policy whenever I am involved in an on the job accident or injury under circumstances that suggest possible involvement or influence in the accident of drugs ore alcohol in the accident or injury event.
By checking this box, I authorize my Digital Signature
Digital Signature
Disclosure
As part of AllStar Security Group, we perform a hiring background and investigation, we may obtain consumer reports or prepare an investigative consumer report. The investigative consumer report may consist of contacting all listed prior employers to verify your employment history. It may also include, but not limited to, credit information reports, criminal history reports, and driving history records. Under the provisions of the Fair Credit Reporting Act (15 USC at 1681-1681u) as amended, before we can seek such records, we must have written permission to obtain that information. You have the right, upon written request, to complete an accurate disclosure of the nature and scope of the investigation. you are also entitled to a copy of your Rights under the Fair Credit Reporting Act.
Authorization to Release Information
Last Name First Name Middle Name Current Address(include street, apt, city, state, and zip)
Addresses for the PAST SEVEN YEARS (include street, apt, city, state, and zip):
Address #1 Dates of Residence Address #2 Dates of Residence Address #3 Dates of Residence Address #4 Dates of Residence Address #5 Dates of Residence Address #6 Dates of Residence Address #7 Dates of Residence Date of Birth Other Names Used (including maiden) Years Used Social Security Number Driver's License Number Email Address
Authorization for Verification of Information and Employment
I Do hereby authorize verification of all information in my employment application from all sources of employment, education, motor vehicle, financial history, criminal history, personal character, and worker's compensation records in compliance with ADA, labor and wage records, etc, or any part thereof, and authorize any duly authorized agent to obtain, whether the said records are public or private, and including those which may be deemed to be privileged or confidential in nature and I release all persons from liability on account of such disclosures, information appearing on this suitability for employment. I certify that I have made true, correct, and complete answers and statements on my employment application, any supplements to it and interview in the knowledge that they will be relied upon in considering my application for employment. I agree to provide additional information that may be requested to process my employment application. I Authorize without reservation any part or agency connected to furnish the above-mentioned information. This authorization is valid during the course of my employment to the extend permitted by law.
I hereby do authorize you to contact my current employer for Employment and Reference Verification. (This will authorize immediate inquiries to the Human Resources Department and to any listed supervisors or references in the Employment/References Section of your application.)
I have the right, upon proper identification, to request the nature and substance of all information into files on me at the time of my request, including sources of information, and the recipients of any reports on me which has been previously furnished within the two year period preceding my request.
I Understand and agree that any omission, false statement, misleading statement, or answer made by me on my application or any supplements to it and in my interviews, will be sufficient grounds for rejection of employment and my discharge after employment.
Disclaimer: This form is not meant to provide legal advice of any kind. Legal advice should be sought from your Attorney. We make no claims, promises or guarantees about the accuracy, completeness, or adequacy of the information contained herein. We make no warranty that this form is appropriate for your particular needs.
