Must have at least one phone number on record
Prefered Method of Contact?
Are you 18 years or older?
Are you authorized to work in the United States?
Have you been previously employed here?
Have you filed an application with us before?
Have you ever been convicted of a crime?
Do you have a valid driver's license?
List professional trade, business or civic activities and offices held excluding groups the name or character of which indicate race, color, religion, sex, national origin, handicap, marital or veterans status, height, weight, or age
State any additional information that you feel may be helpful to us in considering your application.
DISCLOSURE AND AUTHORIZATION FOR RELEASE OF INFORMATION
As part of our hiring background and investigation, we may obtain consumer reports to prepare an investigative consumer report. The investigative consumer report may consist of contacting all listed prior employers to verify your employment history. It may also include, but not limited to, credit information reports, criminal history reports and driving history reports. Under the provision of the Fair Credit Reporting Act (15 USC at 1681-1681u) as amended, before we can see such reports, we must have your written permission to obtain the information. You have the right, upon written request to complete an accurate disclosure of the nature and scope of the investigation. you are also entitled to a copy of your Consumer Rights under the Fair Credit Reporting Act.
AUTHORIZATION AND RELEASE TO OBTAIN INFORMATION
Under the provisions of the Fair Credit Reporting Act, 15 USC, Section 1681 et seq., the Americans with Disabilities Act and all applicable federal, state, and local laws, I hereby authorize and permit Titan Industrial Services, Inc. and it's Agents to obtain a consumer report and/or investigative consumer report which may include the following:
- My employment records:
- Records concerning any driving, criminal history, credit history, civil record, workers' compensation and drug testing:
- (For truck drivers only) In accordance with the Department of Transportation Motor Carrier Safety Regulations, Section 382.413, information concerning alcohol and controlled substances for the past 2 years:
- Verification of my academic and/or professional credentials, and information and/or copies of documents from any military service records.
I authorize Titan Industrial Services, Inc.to receive and review my medical records from occupational Clinic.
I understand that an "investigative consumer report" may include information as to my character, general reputation, personal characteristics, and mode of living, which may be obtained by interviews with individuals with whom I am acquainted or who may have knowledge concerning any such items of information.
I agree that a copy of this authorization has the same effect as an original.
I hereby release and hold harmless any person, firm or entity that discloses matters in accordance with this authorization, as well as Titan Industrial Services, Inc. and it's Agents from liability that might otherwise result from the request for use of and/or disclosure of any or all of the foregoing information.
I understand and acknowledge that under provisions of the Fair Credit Reporting Act, I may request a copy of any consumer report from the consumer-reporting agency that compiled the report, after I have provided proper identification.
I hereby authorize Titan Industrial Services, Inc. and its Agents to obtain and prepare an investigative consumer report as set forth above, as part of its investigation of my employment application.
AUTHORIZATION AND UNDERSTANDING:
Upon the signing of this application, I represent that all of the information now or hereafter given by me in support of my application is true and complete. I authorize you to verify any of the information concerning my employment, education, criminal history, or medical records, with the appropriate individuals, companies, institutions or agencies, and I authorize then to release such information as you require, including my prior disciplinary employment record, without any obligation to give me written notice of such disclosure. I also authorize you to release any information requested by any of my prospective or subsequent employers without any obligation to give me written notice of such disclosure. I hereby release you and them from any liability whatsoever as a result of any such inquiries and disclosures, and this release from liability does not waive nor prohibit an individual from filing a charge of discrimination under the laws enforced by the EEOC. I agree that any false information in support of my application may subject me to discharge at any time during the period of my employment.
I agree that either party may terminate the employment relationship, with or without cause, at any time, and I further agree that this arrangement may only be altered in writing directed to me personally and signed by the president of the company. I agree that I shall be bound by the other rules, policies, regulations and terms and conditions of employment of the company as they are from time to time changed, and no additional obligations can be imposed on the Company except those which have been acknowledged in writing, by the president or his designated representatives. I hereby authorize the company to deduct from each and every pay period of my pay any amounts necessary to offset any damages caused by me or the value of property or money entrusted to me by, or owed by me to the company during the course of my employment.
I agree that any action or suit against the company, its agents or employees, arising out of my employment or termination of employment, including, but not limited to, claims arising under State, but not Federal, civil rights statutes, must be brought within 180 days of the event giving rise to the claims or be forever barred. I waive any limitation periods to the contrary. I further agree that if I should bring any non-statutory action or claim arising out of my employment against the company, in which the company prevails, I will pay the company any and all such costs incurred by the company in defense of said claims or actions, including attorney fees. I further agree that my employment is conditional until such time as the results of my post-offer physical (if such physical is required) are known.