Triad Response Group

Employment Application

Triad Response Group, LLC

Application for Employment

APPLICANTS WILL BE TESTED FOR ILLEGAL DRUGS


Date
Last Name
First Name
Middle Name
Maiden Name
Contact Information Present address:
Number & Street
City
State
Zip Code
How long have you lived at this address?
* Must be 18 or older
Date of Birth
Telephone Number (include area code)
Are you a United States citizen?:	Yes No
Position applied for:
Days/hours available to work (check all that apply):
ANY
Mon
Tues
Wed
Thurs
Fri
Sat
Sun
How many hours can you work weekly?
Can you work nights?:	Yes No
Employment desired::	Full-Time Only Part-Time Only Full or Part-Time
When available for work?
Have you: Ever been employed here before?:	Yes No
Applied for employment here before?:	Yes No
Education Provide information for high school attended below. Include name of school, location (Complete mailing address), Number of years completed, and Degree.
High School
Provide information for every college attended below. Include name of school, location (Complete mailing address), Number of years completed, and Major & Degree.
College
Provide information for every business or trade school attended below. Include name of school, location (Complete mailing address), Number of years completed, and Major & Degree.
Business or Trade School
Provide information for every professional school attended below. Include name of school, location (Complete mailing address), Number of years completed, and Major & Degree.
Professional School
HAVE YOU EVER BEEN CONVICTED OF A FELONY OR MISDEMEANOR?:	No Yes
If yes, when
What State, Parish or Country
What was the nature of the offense?
Driving Information
DO YOU HAVE A DRIVER`S LICENSE?:	Yes No
What is your means of transportation to work?
Driver`s license number
State of issue
Type / Class of License (check all that apply)
Operator
Commercial (CDL)
Chauffer
Expiration date
Have you had any accidents during the past three years?:	Yes No
How many?
Have you had any moving violations including DUI/DWI during the past 3 yrs?:	Yes No
How many?
DUI / DWI?
References Please list two references other than relatives or previous employers. Reference #1:
Name
Position
Company
Address
Telephone (include area code)
Reference #2
Name
Position
Company
Address
Telephone (include area code)
An application form sometimes makes it difficult for an individual to adequately summarize a complete background. Use the space below to summarize any additional information necessary to describe your full qualifications for the specific position for which you are applying. Be sure to include any licenses or special certifications you may hold.
Additional information
Military
Have you ever been in the armed forces?:	Yes No
Are you now a member of the national guard?:	Yes No
Specialty
Date Entered
Date Discharged
Work Experience Please list your work experience for the past four years beginning with your most recent job held. If you were self-employed, give firm name. Upload addition document at bottom of this form if necessary.
1. Name of employer / Address / City, State, Zip Code / Phone number
Name of last supervisor
Employment dates (From - To)
Pay or salary (Start - Final)
Your last job title
Reason for leaving (be specific)
List the jobs you held, duties performed, skills used or learned, advancements or promotions while you worked at this company.
Further information

2. Name of employer / Address / City, State, Zip Code / Phone number
Name of last supervisor
Employment dates (From - To)
Pay or salary (Start - Final)
Your last job title
List the jobs you held, duties performed, skills used or learned, advancements or promotions while you worked at this company.
Further information

3. Name of employer / Address / City, State, Zip Code / Phone number
Name of last supervisor
Employment dates (From - To)
Pay or salary (Start - Final)
Your last job title
Reason for leaving (be specific)
List the jobs you held, duties performed, skills used or learned, advancements or promotions while you worked at this company.
Further information

4. Name of employer / Address / City, State, Zip Code / Phone number
Name of last supervisor
Employment dates (From - To)
Pay or salary (Start - Final)
Your last job title
Reason for leaving (be specific)
List the jobs you held, duties performed, skills used or learned, advancements or promotions while you worked at this company.
Further information
May we contact your present employer?:	Yes No
Did you complete this application yourself?:	Yes No
If not,who did?
APPLICATION FORM WAIVER PLEASE READ CAREFULLY In exchange for the consideration of my job application by Triad Response Group, LLC (hereinafter called "the Company�), I agree that: Neither the acceptance of this application nor the subsequent entry into any type of employment relationship, either in the position applied for or any other position, and regardless of the contents of employee handbooks, personnel manuals, benefit plans, policy statements, and the like as they may exist from time to time, or other Company practices, shall serve to create an actual or implied contract of employment, or to confer any right to remain an employee of the company or otherwise to change in any respect the employment-at-will relationship between it and the undersigned, and that relationship cannot be altered except by a written instrument signed by the President /General Manager of the Company. Both the undersigned and Triad Response Group, LLC may end the employment relationship at any time, without specified notice or reason. If employed, I understand that the Company may unilaterally change or revise their benefits, policies and procedures and such changes may include reduction in benefits. I authorize investigation of all statements contained in this application. I understand that the misrepresentation or omission of facts called for is cause for dismissal at any time without any previous notice. I hereby give the Company permission to contact schools, previous employers (unless otherwise indicated), references, and others, and hereby release the Company from any liability as a result of such contract. I also understand that (1) the Company has a drug and alcohol policy that provides for pre-employment testing as well as testing after employment; (2) consent to and compliance with such policy is a condition of my employment; and (3) continued employment is based on the successful passing of testing under such policy. I further understand that continued employment may be based on the successful passing of job-related physical examinations. I understand that, in connection with the routine processing of your employment application, the Company may request from a consumer reporting agency an investigative consumer report including information as to my credit records, character, general reputation, personal characteristics, and mode of living. Upon written request from me, the Company, will provide me with additional information concerning the nature and scope of any such report requested by it, as required by the Fair Credit Reporting Act. I further understand that my employment with the Company shall be probationary for a period of six(6) months, and further that at any time during the probationary period or thereafter, my employment relation with the Company is terminable at will for any reason by either party.
I accept the terms & conditions of the application waiver above
Items in RED are required.