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 list below? YESNO -- Please Enter Number's In The Boxes Bellow1. Abandonment of a Child2. Abuse3. Abuse of a Child4. Aggravated Abandonment of a Child5. Aggravated Arson6. Aggravated Battery7. Aggravated Burglary8. Aggravated Incest9. Aggravated Robbery10. Aggravated Sodomy11. Aiding Escape12. Altering a Legislative Document13. Arson14. Assault15. Assisting Suicide16. Battery17. Bigamy18. Blackmail19. Bribery20. Burglary21. Contributing to a Child’s Misconduct or Deprivation22. Criminal Damage to Property23. Criminal Nonsupport24. Criminal Restraint25. Criminal Threat26. Electronic Solicitation27. Endangering of a Child28. Exposing Another to a Life Threatening Communicable Disease29. Forgery30. Furnishing Alcoholic Liquor/Beverage or Cereal Malt Beverage to a Minor31. Harassment32. Hazing33. Illegal Use of Weapons of Mass Destruction or Furtherance of Terrorism34. Incest35. Indecent Liberties With a Child/Ward36. Indecent Solicitation of a Child37. Injury to a Pregnant Woman38. Interference with Parental Custody39. Interference with the Conduct of Public Business in a Public Building40. Interference with the Custody of a Committed Person41. Intimidation of a Witness or Victim42. Involuntary Manslaughter43. Kidnapping44. Lewd and Lascivious Behavior45. Making False Writing46. Mistreatment of a Confined Person47. Mistreatment of a Dependent Adult48. Murder49. Obstructing Legal Process or Official Duty50. Official Misconduct51. Patronizing a Prostitute52. Perjury53. Permitting Dangerous Animal to be at Large54. Poisoning55. Possession, Possession with the Intent to Sell56. Promoting Obscenity57. Promoting Prostitution58. Prostitution59. Rape60. Robbery61. Sale, Manufacture or Production of any Drug Listed in the Uniform Controlled Substances Act, KSA 65-4101 et. Seq.62. Sedition63. Sexual Battery64. Sexual Exploitation of a Child65. Sodomy66. Stalking67 Terrorism68. Theft69. Threat, Criminal or Terroristic70. Trafficking71. Treason72. Unlawful Administration of a Substance73. Unlawful Disclosure of Tax Information74. Unlawful Interference75. Unlawful Sexual Relations76. Vehicular Homicide77. Voluntary Manslaughter78. 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.
