Employment Application

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PERSONAL INFORMATION
EDUCATIONAL INFORMATION
WORK INFORMATION
START WITH CURRENT OR MOST RECENT EMPLOYER
DRUG AND ALCOHOL SCREENING

*** I UNDERSTAND THAT IF I AM A QUALIFIED CANDIDATE FOR A JOB OPENING, I WILL BE REQUIRED TO UNDERGO A DRUG AND ALCOHOL SCREENING WITH A SUBSEQUENT NEGATIVE RESULT AS A CONDITION OF EMPLOYMENT. THE SIGNING OF THIS FORM IS MY PERMISSION FOR LEEWAY, INC. OR IT’S AGENT TO TAKE SAMPLES OF MY URINE AND PERFORM A DRUG SCREENING ON SUCH SAMPLES, AND TO TAKE SAMPLES OF MY BREADTH AND PERFORM AN ALCOHOL SCREENING ON SUCH SAMPLES. FURTHER, I GIVE MY CONSENT FOR THE RELEASE OF THE TEST RESULTS TO AUTHORIZED COMPANY MANAGEMENT FOR APPROPRIATE REVIEW ***

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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 A BACKGROUND CHECK INCLUDING BUT NOT LIMITED TO AN INVESTIGATION OF ALL STAEMENTS CONTAINED HEREIN AND THE EMPLOYERS LISTED TO GIVE YOU ANY AND ALL INFORMATION CONCERNING MY PREVIOUS EMPLOYMENT AND ANY PERTINENT INFORMATION THEY MAY HAVE, PERSONAL OR OTHERWISE AND RELEASE ALL PARTIES FROM ALL LIABILITY FOR ANY DAMAGE THAT MAY RESULT FRO FURNISHING SAME TO YOU. I UNDERSTAND AND AGREE THAT, IF HIRED MY EMPLOYMENT IS FOR NO DEFINITE PERIOD AND MAY, REGARDLESS OF THE DATE OF PAYMENT OF MY WAGES AND SALARY, BE TERMINATED AT ANY TIME WITHOUT ANY PRIOR NOTICE. ***

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