Please Read Carefully Before Submitting
That submitting this application does not constitute an offer of employment and that my application may be rejected for any reason.
That giving false or misleading information on this form or in an interview is grounds for denial or immediate termination of employment.
That I may be required to complete a medical history form and may be required to be examined by a medical professional designated by the company at the post-offer stage. I agree that this organization shall be entitled to receive full and complete reports and records governing any medical or related examinations, and I authorize any and all such doctors, medical examiners, and clinics/hospitals to give to this organization full and complete reports and records covering such examinations. Prior to commencing employment, all successful applicants must satisfactorily complete a post-offer pre-employment physical to ensure that the applicant is physically able to perform the essential functions of the job.
That use of illegal drugs is prohibited during employment and that I may be required to undergo and successfully pass a screening for alcohol and/or drugs that is included in a pre-employment physical examination. I also understand that, if employed, I may be required to submit to an alcohol or drug screening according to state law. I agree that this organization shall be entitled to receive full and complete reports and records governing any alcohol or drug screening, and I authorize any and all such doctors, medical examiners, and clinics/hospitals to give to this organization full and complete reports and records covering such examinations. I understand that testing positive for the use of illegal drugs may and likely will result in my not being offered employment.
That if I sustain any injury or illness while in the employment of this organization, I agree that this organization shall be entitled to receive full and complete reports and records governing any medical or related examinations, and I authorize any and all such doctors, medical examiners, and clinics/hospitals to give to this organization full and complete reports and records covering such examinations, condition, care and treatment related to or resulting from the alleged illness or injury.
That this application will be active for a period of 60 days, after that time, if I wish to be considered for employment, I must submit a new application.
Authorization to Release Information
If I am given a conditional offer, I authorize this organization to make a complete investigation of me, including but not limited to my past employment history, scholastic records, criminal activity, motor vehicle driving records, and to receive the results of any physical examination, including the results of alcohol or drug screening, I may be required to undergo and to rely on such information sources. I understand that this organization may request an investigative consumer report from a consumer-reporting agency that includes information as to my character, general reputation, personal characteristics, and mode of living. I understand that the investigative consumer report may involve personal interviews with my neighbors, friends, relatives, former employers, schools, and others. I also understand that under the Federal Fair Credit Reporting Act I have the right to make a written request to this organization within a reasonable time, for the disclosure of the name and address of the consumer reporting agency so that I may obtain a complete disclosure of the nature and scope of the investigation. I authorize all persons and organizations to release any information concerning my background and hereby release all persons and organizations from liability for any damage whatsoever for this information. I acknowledge that a telephone facsimile (fax) or photographic copy shall be as valid as the original. I understand that if employment is obtained under this application, I will comply with all rules and policies of the company. I agree to be responsible for company property and equipment issued to me by the company until returned by me. I agree to pay for property and equipment not returned, and authorize the company to withhold an amount equal to the value of the property not returned by me from final pay. I agree that this authorization to withhold wages constitutes a bona fide written authorization as required under Chapter 91A of the Iowa Code or any similar statute in any other state to withhold wages, and that it is for my benefit that I have provided this authorization.
I understand that this employment application and any other employee related documents are not contracts of employment and that this organization follows an “employment-at-will” policy that an individual who is hired may voluntarily leave employment, and may be terminated by the employer at any time and for any or no reason. I understand that any oral or written statements to the contrary are hereby expressly disavowed and should not be relied upon.
I have read and understand the above release and authorization. If I did not understand, I have had the opportunity to ask questions and obtain any additional information to allow me to understand. I am freely and voluntarily submitting this application.
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