FAIR SALVAGE COMPANY

Employment Application Form

PLEASE PRINT ALL INFORMATION REQUESTED EXCEPT SIGNATURE

APPLICATION FOR EMPLOYMENT

APPLICANTS MAY BE TESTED FOR ILLEGAL DRUG

PLEASE COMPLETE PAGES 1-5.

DATE

Name

Last First Middle

Present address

Number Street City State Zip

How long

Telephone Are you 18 years or older?

Position applied for (1)

and salary desired (2)

(Be specific)

Days/hours available to work

No Pref Thur

Mon Fri

Tue Sat

Wed Sun

How many hours can you work weekly? Can you work nights?

Employment desired qFULL-TIME ONLY qPART-TIME ONLY qFULL- OR PART-TIME

When available for work?

TYPE OF SCHOOL

NAME OF SCHOOL

LOCATION

(Complete mailing address)

NUMBER OF YEARS COMPLETED

MAJOR & DEGREE

High School

College

Bus. or Trade School

Professional School

ARE THERE ANY FELONY CHARGES PENDING AGAINST YOU? q No q Yes

If yes, explain number of conviction(s), nature of offense(s) leading to conviction(s), how recently such offense(s) was/were committed, sentence(s) imposed, and type(s) of rehabilitation.

PLEASE PRINT ALL INFORMATION REQUESTED EXCEPT SIGNATURE

APPLICATION FOR EMPLOYMENT

DO YOU HAVE A DRIVER’S LICENSE? q Yes q No

Do you have reliable transportation to get to work on time?

(Only answer this question if applying for a trucking position)

Driver’s license

number State of issue q Operator q Commercial (CDL) qChauffeur

Expiration date

Have you had any accidents during the past three years?

How many?

Have you had any moving violations during the past three years?

How Many?

OFFICE ONLY

q Yes q Yes Word q Yes

Typing q No WPM 10-key q No Processing q No WPM

Personal q Yes PC q

Computer q No Mac q

Other

Skills

Please list two references other than relatives or previous employers.

Name

Name

Position

Position

Company

Company

Address

Address

Telephone Telephone An application form sometimes makes it difficult for an individual to adequately summarize a complete background. Use the space below to summarize any additional information necessary to describe your full qualifications for the specific position for which you are applying.

PLEASE PRINT ALL INFORMATION REQUESTED EXCEPT SIGNATURE

APPLICATION FOR EMPLOYMENT

MILITARY

HAVE YOU EVER BEEN IN THE ARMED FORCES? q Yes q No

ARE YOU NOW A MEMBER OF THE NATIONAL GUARD? q Yes q No

Specialty Date Entered Discharge Date

Work Experience

Please list your work experience for the past five years beginning with your most recent job held.

If you were self-employed, give firm name. Attach additional sheets if necessary.

Name of employer

Address

Name of last supervisor

Employment dates

Pay or salary

City, State, Zip Code

Phone number

From

To

Start

Final

Your last job title

Reason for leaving (be specific)

List the jobs you held, duties performed, skills used or learned, advancements or promotions while you worked at this company.

Name of employer

Address

Name of last supervisor

Employment dates

Pay or salary

City, State, Zip Code

Phone number

From

To

Start

Final

Your Last Job Title

Reason for leaving (be specific)

List the jobs you held, duties performed, skills used or learned, advancements or promotions while you worked at this company.

PLEASE PRINT ALL INFORMATION REQUESTED EXCEPT SIGNATURE

APPLICATION FOR EMPLOYMENT

Work experience

Please list your work experience for the past five years beginning with your most recent job held.

If you were self-employed, give firm name. Attach additional sheets if necessary.

Name of employer

Address

Name of last supervisor

Employment dates

Pay or salary

City, State, Zip Code

Phone number

From

To

Start

Final

Your last job title

Reason for leaving (be specific)

List the jobs you held, duties performed, skills used or learned, advancements or promotions while you worked at this company.

Name of employer

Address

Name of last supervisor

Employment dates

Pay or salary

City, State, Zip Code

Phone number

From

To

Start

Final

Your last job title

Reason for leaving (be specific)

List the jobs you held, duties performed, skills used or learned, advancements or promotions while you worked at this company.

May we contact your present employer? q Yes q No

Did you complete this application yourself q Yes q No

If not, who did?

PLEASE READ CAREFULLY

APPLICATION FORM WAIVER

In exchange for the consideration of my job application by Fair Salvage Company (hereinafter called “the Company”), I agree that:

Neither the acceptance of this application nor the subsequent entry into any type of employment relationship, either in the position applied for or any other position, and regardless of the contents of employee handbooks, personnel manuals, benefit plans, policy statements, and the like as they may exist from time to time, or other Company practices, shall serve to create an actual or implied contract of employment, or to confer any right to remain an employee of Fair Salvage Company, or otherwise to change in any respect the employment-at-will relationship between it and the undersigned, and that relationship cannot be altered except by a written instrument signed by the President /General Manager of the Company. I understand that, if hired, I will be an at-will employee, and that both the undersigned and Fair Salvage Company may end the employment relationship at any time, without specified notice or reason. If employed, I understand that the Company may unilaterally change or revise their benefits, policies and procedures and such changes may include reduction in benefits.

I authorize investigation of all statements contained in this application. I understand that the misrepresentation or omission of facts called for is cause for disqualification from further consideration for employment or dismissal at any time without any previous notice. I hereby give the Company permission to contact schools, previous employers (unless otherwise indicated), references, and others, and hereby release the Company from any liability as a result of such contract. Further, I specifically waive prior written notice of disclosure of my personnel record information, including disciplinary reports, letters of reprimand or other disciplinary action.

I also understand that (1) the Company has a drug and alcohol policy that provides for preemployment testing as well as testing after employment; (2) consent to and compliance with such policy is a condition of my employment; and (3) continued employment is based on the successful passing of testing under such policy. I further understand that my initial and continued employment may be based on the successful passing of job-related physical examinations. I hereby consent to the release of any medical information obtained pursuant to these policies. In consideration of employment, I agree to conform to the rules and policies of the company. I acknowledge and agree that in consideration for the company reviewing the attached application and for my potential future employment, any action or suit against the company arising out of my application, employment or termination of employment, including but not limited to claims arising under state or federal civil rights statutes, must be brought within 180 calendar days of the event giving rise to the claims or be forever barred. I waive any limitation periods that might otherwise be applicable.

I understand that, in connection with the routine processing of your employment application, the Company may make investigative inquiries on my background, including a criminal record check, driving record check, social security trace, credit check and education verification. I acknowledge that any offer of employment and continued employment is contingent upon the results of the investigation.

I further understand that my employment with the Company shall be probationary for a period of sixty (60) days, and further that at any time during the probationary period or thereafter, my employment relation with the Company is terminable at will for any reason by either party.

Signature of applicant Date:

This Company is an equal employment opportunity employer. We adhere to a policy of making employment decisions without regard to race, color, religion, sex, sexual orientation, national origin, citizenship, age or disability. We assure you that your opportunity for employment with this Company depends solely on your qualifications.

Thank you for completing this application form and for your interest in our business.

Contact this candidate