APPLICANT NOTE
This application form is intended or used in evaluating your qualifications for employment. This is not an employment contract. Please answer all appropriate questions completed and accurately. Please do not fill out any part of this section you believe to be non-job related.
False or misleading statements during the interview and on this form are grounds for terminating the application process or, if discovered after employment terminating employment. All qualified applicants will receive consideration without discrimination because of sex, marital status, race, age, creed, national origin or the presence of disabilities. A felony conviction will not necessarily bar an applicant from employment. Additional testing of job-related skills and for the presence of drugs in your body will be required prior to employment. After an offer of employment, and prior to reporting to work, you are required to submit to a medical review. Depending on the needs of the job, you will be required to complete a medical history form and be required to be examined by a medical professional designated by the Company.
TO BE READ AND SIGNED BY APPLICANT
I authorize you to make sure investigations and inquiries to my personal, employment, financial or medical history and other related matters as may be necessary in arriving at an employment decision. (Generally, inquiries regarding medical history will be made only if and after a conditional offer of employment has been extended.) I hereby release employers, schools, health care providers and other persons from all liability in responding to inquiries and releasing information in connection with my application
In the event of employment, I understand that false or misleading information given in my application or interview(s) may result in discharge. I understand, also, that I am required to abide by all rules and regulations of the Company.
“I understand that information I provide regarding current and/or previous employers may be used, and those employer(s) will be contacted, for the purpose of investigating my safety performance history as required by 49 CFR 391.23(d) and (e). I understand that I have the right to:
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Review information provided by current/previous employers;
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Have errors in the information corrected by previous employers and for those previous employers to re-send the corrected information to the prospective employer; and
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Have a rebuttal statement attached to the alleged erroneous information, if the previous employer(s) and I cannot agree on the accuracy of the information.”
CERTIFICATION AND RELEASE
I certify that I understand and have read, or someone has read to me, the applicant note on page one of this form and that the answers given by me to the foregoing questions and the statements made by me are complete and true to the best of my knowledge and belief. I understand that any false information or misrepresentations of facts in this application may result in rejection of my application or discharge at any time during my employment. I authorize Heartland Asphalt, Inc. and/or its agents, including consumer reporting bureaus, to verify any of this information. I authorize all former employers, persons, schools, companies and law enforcement authorities to release any information concerning my background and hereby release any said persons, schools, companies and law enforcement authorities from any liability for any damage whatsoever for issuing this information. I also understand that the use of illegal drugs is prohibited during employment. If company policy requires, I am willing to submit to drug testing to detect the use of illegal drugs prior to and during employment. I understand that a pre-employment physical may be required and submit to this pre-employment physical.
