General Application – Smith Industries




Smith Industries Employment Application


Name





Current Address







APPLICANT INFORMATION







REQUIRED QUESTIONS



Have you ever been convicted of a felony? (Y/N)
YesNo

Are you a U.S. Citizen? (Y/N)
YesNo

If selected for employment, are you willing to submit to a pre-employment drug screen?? (Y/N)
YesNo



PREVIOUS EXPERIENCE

Must list the complete mailing address: street number and name, city, state and zip code.


LAST EMPLOYER





SECOND LAST EMPLOYER





THIRD LAST EMPLOYER





FOURTH LAST EMPLOYER




TO BE READ AND E-SIGNED BY APPLICANT



I authorize Smith Industries to make investigations and inquiries to my personal, employment, financial and other related matters as may be necessary in arriving at an employment decision. I hereby release employers, schools, and other persons from all liability in responding to inquiries and releasing information in connection with my application.

In the event of employment, I understand that false or misleading information given in my application or interview(s) may result in discharge. I understand, also, that I am required to abide by all rules and regulations of the Smith Industries if hired.

I understand that information I provide regarding current and/or previous employers may be used, and those employer(s) will be contacted, for the purpose of investigating my safety performance history as may be required by 49 CFR 391.23(d) and (e). I understand that I have the right to:

• Review information provided by current/previous employers;

• Have errors in the information corrected by previous employers and for those previous employers to re-send the corrected information to the prospective employer;
and

• Have a rebuttal statement attached to the alleged erroneous information, if the previous employer(s) and I cannot agree on the accuracy of the information.”

All information is to be used in the decision making for employment with Smith Industries.

This certifies that I completed this application, and that all entries on it and information in it are true and complete to the best of my knowledge.