Medical assistant

Application Details

Candidate Name: Nora Neely

Applied For: Machine Operator (55934)

Date Applied: 07/09/2022 02:06:51 AM

Description Date Completed

Welcome & Privacy Acknowledgment 07/09/2022

View/Update Contact Information 07/09/2022

View/Update Contact Information

Confirm Your Legal Name

Given Name (First): Nora Middle Name: Howard Family Name

(Last):

Neely Preferred

First Name:

Nora

Legal Local Name: Nora Howard Neely

Where Do You Live?

United States Change Country?: United States

Street Address *: 166 bens branch road

City *: Newington

State/Province

Abbreviation *:

GA Georgia

Post Code *: 30446

How Do We Contact You?

Primary Email: **********@*****.***

Personal Mobile

Country Code: +1 Phone Number: 912-***-**** Enter Numbers only in Phone Number

field, including area

code.:

No special

characters or

formatting allowed.

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Yes

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Preferences

Willing To Relocate?: Yes

Salary Expectation?: 20.000000 Currency: USD Pay Rate Type: Hourly Description Date Completed

Employment History 07/09/2022

Employment History

Job Title Employer Name Start Date End Date

Current

Employer

Produce associate Food lion August 2021 June 2022 No Machine operator Austin machine shop May 2010 August 2019 No Co owner Neely pallets February 1997 September 2006 No Medical office assistant Medical college of ga June 1994 June 1996 No Description Date Completed

Voluntary Self-Identification 07/09/2022

Voluntary Disability Self-Identification 07/09/2022 Questions 07/09/2022

Questions

Question Text Question Answer

Are you at least 18 years of age? Yes

Are you legally authorized to work in the United States? Yes Will you now or in the future require sponsorship for employment visa status (for example, EAD, F-1, OPT, H-1B, L-1, or TN status)? If employed, you will be required to provide original documents which verify your identity and right to work in the United States. No

Have you previously worked for a Koch affiliated company (ex. Georgia-Pacific, INVISTA, Flint Hills Resources, Molex, Guardian Industries, SRG Global, etc.), or have previously been a Koch contractor? If yes, please provide details.

No

Do you have relatives who are currently employed by a Koch affiliated company (ex. Georgia-Pacific, INVISTA, Flint Hills Resources, Molex, Guardian Industries, SRG Global, etc.), or who have pending offers? If yes, please provide your relative's name. No

Have you at any time signed a non-compete, non-solicitation, confidential information or similar agreement with any previous employer?

No

Do you have at least six (6) months or more of experience in a manufacturing, industrial, farming, construction, and/or military environment?

No

Do you have Operations experience on converting equipment ? Yes Do you have a minimum of one (1) year experience

troubleshooting and repairing equipment?

Yes

Do you have experience working swing shift or night shift? No Do you have experience working with others or as part of a team? Yes Description Date Completed

Attachments (Optional) 07/09/2022

Attachments (Optional)

Description Date Completed

Sign Application 07/09/2022

Sign Application

Please read the following statement carefully, then acknowledge that you have read and approved it by providing the information requested at the bottom of the page. Please note that an eSignature is the electronic equivalent of a hand-written signature. By my signature on this Employment Application, I certify that all information furnished by me and in any resume I have supplied, is true, complete and correct. I agree that any false statement made by me, or my failure to answer completely any applicable questions may result in release from, or refusal of, employment. I understand that if I am offered employment, I may be required to sign a non-solicitation and non-disclosure agreement, as a condition of employment. By signing and submitting this Employment Application, I certify I am genuinely interested in working for the Company in the position which I am applying and am submitting this Employment Application for no other purpose. I acknowledge that I have read this Employment Application carefully and understand its content. This Employment Application may be executed in one or more counterparts or duplicate originals, all of which when taken together will constitute one and the same document. Electronic and facsimile copies of an original executed signature page (including copies electronically transmitted in portable document format or “.pdf”) will be deemed the same as the original executed signature page. Electronically executed versions of a signature page through the electronic signing system implemented by either Party will also be deemed the same as an original executed signature page. At the request of either Party, the other parties to this Employment Application will promptly confirm all electronic or facsimile copies, and all electronically executed versions, of any signature page by manually executing and delivering a duplicate original signature page. If hired, as an employee of the Company, I will follow the rules, regulations and policies of the Company, which will govern the terms and conditions of my employment. If I am hired, I understand the employment relationship will be at-will, meaning I am not guaranteed employment for any definite period, and my employment relationship may be terminated at any time, without cause or notice, for any or no reason, by either the Company or myself. I understand any agreement to the contrary must be in writing and signed by an authorized representative of the Company. I certify that no employee or representative of the Company has made any oral or written representation to me or entered into any agreement with me that is contrary to this Certification and Agreement. I further understand and agree that, except for employment-at-will status, if hired my wages, hours, working conditions, job assignment(s), and compensation rate(s) will be subject to change by the Company. I understand that if I am offered employment, such offer will be contingent upon passing a Company-approved drug screen in accordance with state law, that I may be required to complete a medical history questionnaire and/or undergo a physical examination by a physician selected by the Company; and that I will be required to supply proof of authorization to work in the U.S. I also understand that I will be required to authorize the drug testing firm to provide the results of the required drug test to the Company. I also understand and agree that by signing and submitting this Employment Application, I am waiving my right to have a jury trial to resolve any lawsuit I may ever bring against the Company, and that any lawsuit that I may bring against the Company will be tried to a judge without a jury. I also understand and agree that I am waiving my right to participate as a member in a class action lawsuit and/or act as a representative of a class of similarly situated individuals in any lawsuit against the Company. I understand that unless I waive these rights, the Company will not further consider my application for employment. MARYLAND APPLICANTS: 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. MASSACHUSETTS APPLICANTS: It is unlawful in Massachusetts to require or administer a lie detector test as a condition of employment or continued employment. An employer who violates this law shall be subject to criminal penalties and civil liabilities. RHODE ISLAND APPLICANTS: The Company is subject to Chapter 29-38 of Title 28 of the Rhode Island Workers' Compensation Law.

MONTANA APPLICANTS: The employment relationship is governed by the Wrongful Discharge from Employment Act. Mont. Code 39-2-901.

Signature

READ THE ABOVE CERTIFICATION AND AGREEMENT CAREFULLY. By my eSignature below, I certify that I have read, fully understand and accept all terms of the foregoing statement. Please signify your acceptance by entering the information requested in the fields below.

* I Agree: Yes

Your Name: Nora Howard Neely Signed: 07/09/2022

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