Name *

First Name

Last Name

Phone *

(###)

###

####

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Date You Can Start *

MM

DD

YYYY

Are You A Citizen Of The United States? *

Yes

No

Have You Ever Worked For Best-Tec? *

Yes

No

Have You Ever Been Convicted Of A Felony? *

Yes

No

Did You Graduate? (High School)

Yes

No

Did You Graduate? (College)

Yes

No

Did You Graduate? (Other)

Yes

No

Have You Ever Served In The US Armed Forces?

Yes

No

Reference #1

First Name

Last Name

Reference #1 Phone

(###)

###

####

Reference #2

First Name

Last Name

Reference #2 Phone

(###)

###

####

Reference #3

First Name

Last Name

Reference #3 Phone

(###)

###

####

Name Of Present/Last Supervisor

First Name

Last Name

Present/Last Employer Phone

(###)

###

####

Present/Last Employer Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

May We Contact Your Present/Last Employer

Yes

No

Name Of Previous Employer #2 Supervisor

First Name

Last Name

Previous Employer #2 Phone

(###)

###

####

Previous Employer #2 Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

May We Contact Your Previous Employer #2?

Yes

No

APPLICANT'S STATEMENT *


By submitting this form, I affirm and certify that all the information and answers to questions herein are complete, true and correct to the best of my knowledge and belief. I understand that any misrepresentation, falsification, or omission of any facts called for in the application may render this application void and will be cause for termination, whenever discovered.

I authorize the companies to conduct any investigation it deems appropriate concerning my application. I hereby authorize and request former employers, personal references, schools, government agencies, health care providers, and all other persons and organizations to disclose credit, criminal record, employment and any other information that may be sought in connection with this application. I hereby release all of the above mentioned from all liability in connection with those disclosures. I further authorize the companies to disclose to others any information it may have concerning my employment, character, and qualifications, including information gained from this application and the investigation of this application. I herein release the companies from all liability in connection with those disclosures. As a condition of my hiring and continued employment, I agree to submit to examinations (including blood, urine, and/or breath test), at the company’s expense, by the person designated by the company, whenever the company requests or at any time during my employment. I promise and pledge that I will not steal or take from the companies or its employees. I understand and agree that any employment that may result from this application will be for no definite period or duration is at the will of the companies, and may be terminated at any time, without notice or cause. This type of employment is considered to be “employment at will” for the purposes of this agreement. If employed, I agree to acquaint myself with and to abide by all rules, regulations, policies, and procedures of the companies. I acknowledge and agree that the companies have the absolute unfettered right to change its rules, regulations, instructions, policies, procedures, practices, benefits or compensation arrangements unilaterally, at any time, without prior notice. I understand and agree that no person, except a managing partner or managing officer of the company has the authority to bind the company or enter into an agreement with me regarding the duration of employment or any terms of my employment. I further agree that no such agreement will be enforceable unless in writing and signed by the president of the specific company.

I have read the above statements, I understand them, and I agree to them. I understand that I am being employed at the employers will and may be dismissed at any time without any notice, cause or reason. I understand and agree that all these terms are reasonable, fair, and acceptable to me. I have not been coerced, threatened, or intimidated into signing this statement; instead, it is of my own free will.

First Name

Last Name

Today's Date *

MM

DD

YYYY