Employment Application Applicant Information Last Name (required) First Name (required) Middle Initial Street Address Apartment/Unit # City State Zip Phone Number Email Address (required) Date Available Shift 123Any Desired Salary Position applied for (Check all that apply) PackerMaterial HandlerMaintenanceOther Are you a citizen of the United States? YESNO If NO, are you authorized to work in the U.S.? YESNO Have you ever applied to this company? YESNO If so, when? Do you have any relatives that work here? YESNO If so, who? What form of transportation do you have? Personal AutoBikeWalkFriend/Relative Education High School Address Did you graduate? YESNO Degree College Address Did you graduate? YESNO Degree Other Address Did you graduate? YESNO Degree References Full Name Relationship Company Phone Number Address Full Name Relationship Company Phone Number Address Full Name Relationship Company Phone Number Address Previous Employment Please list your most recent employer first. Company Phone Address Supervisor Job Title Starting Salary Ending Salary Responsibilities From To Reason for Leaving May we contact this employer for a reference? YESNO Company Phone Address Supervisor Job Title Starting Salary Ending Salary Responsibilities From To Reason for Leaving May we contact this employer for a reference? YESNO Company Phone Address Supervisor Job Title Starting Salary Ending Salary Responsibilities From To Reason for Leaving May we contact this employer for a reference? YESNO Company Phone Address Supervisor Job Title Starting Salary Ending Salary Responsibilities From To Reason for Leaving May we contact this employer for a reference? YESNO Criminal Record Have you ever been convicted of any of the offenses in the drop-down list below? YESNO Click for list of offenses Abandonment of a Child Abuse Abuse of a Child Aggravated Abandonment of a Child Aggravated Arson Aggravated Battery Aggravated Burglary Aggravated Incest Aggravated Robbery Aggravated Sodomy Aiding Escape Altering a Legislative Document Arson Assault Assisting Suicide Battery Bigamy Blackmail Bribery Burglary Contributing to a Child’s Misconduct or Deprivation Criminal Damage to Property Criminal Nonsupport Criminal Restraint Criminal Threat Electronic Solicitation Endangering of a Child Exposing Another to a Life Threatening Communicable Disease Forgery Furnishing Alcoholic Liquor/Beverage or Cereal Malt Beverage to a Minor Harassment Hazing Illegal Use of Weapons of Mass Destruction or Furtherance of Terrorism Incest Indecent Liberties With a Child/Ward Indecent Solicitation of a Child Injury to a Pregnant Woman Interference with Parental Custody Interference with the Conduct of Public Business in a Public Building Interference with the Custody of a Committed Person Intimidation of a Witness or Victim Involuntary Manslaughter Kidnapping Lewd and Lascivious Behavior Making False Writing Mistreatment of a Confined Person Mistreatment of a Dependent Adult Murder Obstructing Legal Process or Official Duty Official Misconduct Patronizing a Prostitute Perjury Permitting Dangerous Animal to be at Large Poisoning Possession, Possession with the Intent to Sell Promoting Obscenity Promoting Prostitution Prostitution Rape Robbery Sale, Manufacture or Production of any Drug Listed in the Uniform Controlled Substances Act, KSA 65-4101 et. Seq. Sedition Sexual Battery Sexual Exploitation of a Child Sodomy Stalking Terrorism Theft Threat, Criminal or Terroristic Trafficking Treason Unlawful Administration of a Substance Unlawful Disclosure of Tax Information Unlawful Interference Unlawful Sexual Relations Vehicular Homicide Voluntary Manslaughter Any other crimes including attempts, conspiracies, and solicitation to commit any of the crimes listed If YES, give details, including offense, date and location. Offense # Date Convicted Details (including location where conviction occurred) Offense # Date Convicted Details (including location where conviction occurred) Offense # Date Convicted Details (including location where conviction occurred) Notice: Prior convictions will not necessarily bar you from employment with this company. Military Service Branch From To Rank at Discharge Type of Discharge If other than Honorable, explain: Disclaimer and Signature Please read carefully! In exchange for the consideration of my job application by Container Services, Inc. (hereinafter referred to as “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 Container Services, Inc., 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 /Owner of the Company. Both the undersigned and Container Services, Inc. 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 contact. 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 my 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 provisional for a period of ninety (90) days, and further that at any time during the provisional period or thereafter, my employment relation with the Company is terminable at will for any reason by either party. Signature: Sign by clicking and dragging your cursor in the box below. Alternatively, you may type your full name in here as your signature: Date This Company is an equal employment opportunity employer. We adhere to a policy of making employment decisions without regard to race, color, religion, sex, sexual orientation, national origin, citizenship, age or disability. We assure you that your opportunity for employment with this Company depends solely on your qualifications. Thank you for completing this application form and for your interest in our business.