Attention: Applicant/Candidate for Employment
You are aware that criminal and motor vehicle reports (MVR) will be obtained as part of J& W Services and Equipment Company’s (J&W) evaluation for your application of employment. The reports will be procured by J&W or its designated representative and may include personal information obtained from state motor vehicle departments and state and local law enforcement agencies. J& W’s assessment will help identify your insurability and other considerations for employment.
By signing this form, you provide authorization for J&W or its designated representative to produce such information and reports, as well as additional reports about you from time-to-time as deemed appropriate to evaluate insurability and other acceptable purposes for employment with J&W.
Sincerely,
J&W Services and Equipment Company
Applicant :
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Personal Information
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Employment Desired
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Education History
Grammar School
High School
College
Trade, Business or Correspondence School
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General Information
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Former Employers
List below last four Employers, starting with last one first
Employer 1
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References
Give below the names of three persons not related to you, whom you’ve known at least one year.
Person 1
Person 2
Person 3
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Authorization
“I certify that the facts contained in this application are true and complete to the best of my knowledge and understand that, if employed, falsified statements on this application shall be grounds for dismissal.
I authorize investigation of all statements contained herein and the references and employers listed above to give you any and all information concerning my previous employment and any pertinent information they may have, personal or otherwise, and release the company from all liability for any damage that may result from utilization of such information.
I also understand and agree that no representative of the company has any authority to enter Into any agreement for employment for any specified period of time, or to make any agreement contrary to the foregoing, unless it is in writing and signed by an authorized company representative.
This waiver does not permit the release or use of disability-related or medical Information in a manner prohibited by the Americans with Disabilities Act (ADA) and other relevant federal and state laws.”
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