An Equal Opportunity Employer

IN CONNECTION WITH MY APPLICATION FOR EMPLOYMENT (INCLUDING CONTRACT FOR SERVICES) WITH YOU, I UNDERSTAND THAT INVESTIGATIVE BACKGROUND INQUIRIES ARE TO BE MADE ON MYSELF INCLUDING CONSUMER, CRIMINAL, DRIVING, AND OTHER REPORTS.  THESE REPORTS WILL INCLUDE INFORMATION AS TO MY CHARACTER, WORK HABITS, PERFORMANCE AND EXPERIENCE ALONG WITH REASONS FOR TERMINATION OF PAST EMPLOYMENT FROM PREVIOUS EMPLOYERS.  FURTHER, I UNDERSTAND THAT YOU WILL BE REQUESTING INFORMATION FROM VARIOUS FEDERAL, STATE AND OTHER AGENCIES WHICH MAINTAIN RECORDS CONCERNING MY PAST ACTIVITIES RELATING TO MY DRIVING, CREDIT, CRIMINAL, CIVIL AND OTHER EXPERIENCES.

I AUTHORIZE, WITHOUT RESERVATION, ANY PARTY OR AGENCY CONTRACTED BY THIS EMPLOYER TO FURNISH THE ABOVE MENTIONED INFORMATION.

PRINT FULL NAME _________________________________________________________________

SOC. SEC. NO. ______-______-_________   ***DATE OF BIRTH ____/____/________

CURRENT ADDRESS _______________________________________________________________

CITY / STATE / ZIP __________________________________________________________________

DRIVER'S LICENSE NO. _________________________________  STATE ____________________

APPLICANT'S SIGNATURE __________________________________________________________

DATE _________________________

PROSPECTIVE EMPLOYER __________________________________________________________

***Date of Birth is being requested in order to obtain accurate retrieval of records.

Please feel free to fax a resume to
Human Resources at (256) 734-3336

or e-mail info@McGriffindustries.com