WE ARE A DRUG FREE WORKPLACE. VALID DRIVER'S LICENSE AND RESPONSIBLE DRIVING RECORD REQUIRED
TANK SERVICES
EMPLOYMENT APPLICATION
We are an equal opportunity employer, dedicated to a policy of non-discrimination in employment on any basis including age, sex, color, race, creed, national origin, religious persuasion, marital status, political belief, or disability that does not prohibit performance of essential job functions.
This application will be given every consideration, but its receipt does not imply that the applicant will be employed. Each question should be answered in a complete and accurate manner as no action can be taken on this application until all questions have been answered.
Federal law prohibits the employment of unauthorized aliens. All persons hired must submit satisfactory proof of employment authorization and identity (valid driver’s license, birth certificate, Green Card, etc.) within three days of being hired. Failure to submit such proof within the required time shall result in immediate employment termination.
School Name & Location
Years Completed
Degree
Please provide all employment for the last five years, beginning with your current or most recent employer. Attach additional sheet(s) if necessary.
1.
Company Name: (Current/Most Recent Employer)
Position Held:
Manager/Supervisor Name:
Phone Number:
Reason for Leaving:
Wage/Salary:
2.
Company Name:
Position Held:
Manager/Supervisor Name:
Phone Number:
Reason for Leaving:
Wage/Salary:
3.
Company Name:
Position Held:
Manager/Supervisor Name:
Phone Number:
Reason for Leaving:
Wage/Salary:
4.
Company Name:
Position Held:
Manager/Supervisor Name:
Phone Number:
Reason for Leaving:
Wage/Salary:
Tank Services reserves the right to contact all employers listed on this application, unless you specifically wish to exclude them. Below, please list any employers you do not want us to contact and your reason for the exclusion:
List details for three professional work references. Do not list relatives.
1.
Full Name:
Phone Number:
Company Name & Occupation
E-Mail:
Relationship to you:
Years Known:
2.
Full Name:
Phone Number:
Company Name & Occupation
E-Mail:
Relationship to you:
Years Known:
3.
Full Name:
Phone Number:
Company Name & Occupation
E-Mail:
Relationship to you:
Years Known:
I certify that my answers to the forgoing questions are true and correct without any consequential omissions of any kind. I understand that if I am employed, any false, misleading, or otherwise incorrect statements made on this application form or during any interviews may be grounds for my immediate discharge.
I hereby authorize Tank Services to contact any company or individual it deems appropriate to investigate my employment history, character, and qualifications and I give full and complete consent to their revealing any and all information they wish as a result of this investigation. In addition, I hereby waive my right to bring any cause of action against these individuals for defamation, invasion of privacy or any other reason because of their statements.
I agree that, if I am employed, I will abide by all the rules and regulations of Tank Services. I understand that the taking of drug and alcohol tests, given pursuant to agency policy, is a condition of continued employment and refusal to take such tests will be grounds for my immediate termination. I further understand that nobody of Tank Services is authorized to enter into any written or verbal employment contracts with me for any definite period of time without the written consent of the C.E.O. of Tank Services. I also understand that my employment is “at-will” and may be terminated by myself or by Tank Services at any time for any reason, or no reason at all, with or without prior notice.
I certify that I have read, fully understand, and accept all terms of the foregoing Applicant Affidavit.
Print Full Name
Signature
Date
Release of Information Form – 49 CFR Part 40 Drug and Alcohol Testing
SECTION I: To be completed by applicant/employee
Applicant Authorization to Release DOT Drug/Alcohol Test Results
I understand that as a condition of hire with Tank Services, that I must consent to the release of the results of all DOT mandated drug and alcohol information from all companies for which I have worked in a DOT safety-sensitive position, or for which I took a DOT pre-employment drug test during the previous two (2) years as required by DOT Part 40, Section 40.25. I authorize my prior employer(s) to release the information requested below in Section II to Tank Services.
Check appropriate box, only if applicable:
(Complete additional form for each prior DOT employer)
Certification: I have read and fully understand this authorization to release my previous drug and alcohol test information to Tank Services. I hereby acknowledge that failure to provide accurate information in response to this request for release of information could negatively affect my employment offer or subject me to disciplinary action up to and including termination if later discovered after my employment with the Company begins. I further understand that I am responsible for any costs associated with any pending Substance Abuse Professional Assessment, recommendations, education, and/or treatment including return-to-duty testing and/or follow-up testing.
SECTION II: To be completed by applicant/employee's previous employer
Applicant Authorization to Release DOT Drug/Alcohol Test Results
In accordance with DOT regulations, Tank Services is required to obtain -- and as a Previous Employer, you are required to release -- DOT drug and alcohol information, listed below, concerning the Applicant/Employee, named above. This information request covers any period of employment of the Applicant/Employee by you going back 2 years from the date of this request. Please complete the following:
NOTE : If "YES" for item 5, you must provide the previous employer’s report. If “YES” for item 6, you must also transmit the appropriate returnto-duty documentation (e.g., SAP Report(s), follow-up testing record).
Company Name
Name of Person Completing Form
Date
DISCLOSURE REGARDING BACKGROUND CHECK
Services Acquisition Company LLC dba Tank Services may obtain information about you from a third-party consumer reporting agency for employment purposes. Thus, you may be the subject of a “consumer report” which may include information about your character, general reputation, personal characteristics, and/or mode of living. These reports may contain information regarding your criminal history, social security verification, motor vehicle records (“driving records”).
You have the right, upon written request made within a reasonable time, to request whether a consumer report has been run about you and to request a copy of your report. These searches will be conducted by IntelliCorp Records, Inc., 3000 Auburn Drive, Suite 410, Beachwood, Ohio 44122; Tel. No. 1.888.946.8355; www.intellicorp.net.
Print Full Name
Signature
Date
ACKNOWLEDGMENT AND AUTHORIZATION FOR BACKGROUND CHECK
I acknowledge receipt of the separate stand-alone Disclosure and certify that I have read and understand it and this authorization. I hereby authorize the obtaining of “consumer reports” and/or “investigative consumer reports” by Services Acquisition Company LLC dba Tank Services at any time after receipt of this authorization and throughout my employment, if applicable. To this end, I hereby authorize, without reservation, any law enforcement agency, administrator, state or federal agency, institution, school or university (public or private), information service bureau, employer, or insurance company to furnish any and all background information requested by IntelliCorp Records, Inc., 3000 Auburn Drive, Suite 410, Beachwood, Ohio 44122; Tel. No. 1.888.946.8355; www.intellicorp.net.
I doI do not
authorize you to contact, through IntelliCorp Records, Inc., my current employer for Employment and Reference Verifications. (Checking “I do” will authorize inquiries to the Human Resources Department and to any listed supervisors.)
I also consent to have any legally required notices sent electronically.
Print Full Name
Signature
Date
First Name
Middle Name
Last Name
Current Address
Dates Lived Here
Date of Birth
Other Names Used (including maiden)
Years Used
Social Security Number
Driver's License #
DL-State
Email address (required for official correspondence)