Bright Sky Group of Services

Application for Employment eSignature


Application Cover Page

Employee First Name:   Employee Last Name:  

New or Rehire:   Hired or Backup:

Location:   Client:   

Position Type:

Regular Pay Rate (per hour):   Overtime Pay Rate (per hour):  

Permanent or Temporary:   Full- or Part-Time:   Pay Form:  

Sent by:   

Medical Coverage:  

Employee will be employed at Republic Services:  

Application for Employment

PERSONAL INFORMATION

Last Name:   First Name:   Middle Initial:   

Address:   

Phone Number:   Email:

Date of Birth: 01-01-1970  Social Security:

 

EDUCATION HISTORY

High School Name & Location:   Years Attended:

Graduate?   Subjects Studied:  

 

College/Trade School/Military Name & Location:   Years attended:

Graduate?   Subjects Studied:

 

EMPLOYMENT HISTORY

(Starting with the most recent position, list of last three employers)

1 | Dates employed:   Name & Address of Employer:

Position:   Reason for Leaving:  

 

2 | Dates employed:   Name & Address of Employer:  

Position:   Reason for Leaving:  

 

3 | Dates employed:   Name & Address of Employer:

Position: Reason for Leaving:

REFERENCES

(List three persons you have known at least one year and are not related to you)

1 | Name:   Business:  

Address:  Years Known:

 

2| Name:  Business:

Address:   Years Known:  

 

3| Name:   Business:

Address:   Years Known:  

 

AUTHORIZATION, WAIVER AND ELECTRONIC SIGNATURE CONSENT

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 agree that I will not commence any action or lawsuit relating to my employment or application for employment with National Star Services and its affiliates more than 6 months after the employment action that is the subject of the action or lawsuit, and I agree to waive any statute of limitations to the contrary. I understand that this means that even if the law would give me the right to wait a longer time to make a claim, I am freely and knowingly waiving that right, and that any claims not brought within 6 months after the relevant employment action will be barred.

I authorize investigation of all statements contained herein and the references and employers listed above to give you any and all information concerning my previous employment and any pertinent information they may have, personal or otherwise, and release the company from all liability for any damage that may result from utilization of such information.

I also understand and agree that no representative of the company has any authority to enter into any agreement for employment for any specified period of time, or to make any agreement contrary to the forgoing, unless it is in writing and signed by an authorized company representative.

This waiver does not permit the release or use of disability–related or medical information in a manner prohibited by the Americans with Disabilities Act (ADA) and other relevant federal and state laws.

I also agree that by using an e-signature feature, I am applying my electronic signature, which is the legally binding equivalent to my handwritten signature. Whenever I execute an electronic signature, it has the same validity and meaning as my handwritten signature. I also agree that no certification authority or other third party verification is necessary to validate my e-signature.

 
 

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Signature Certificate
Document name: Application for Employment eSignature
lock iconUnique Document ID: 8f44e3cde43ace276a3d03d15c814497a3ffd074
Timestamp Audit
January 14, 2021 8:51 pm CSTApplication for Employment eSignature Uploaded by Megan Ford - megan@meganforddesign.com IP 98.213.216.126