Person to notify in case of emergency:
Work ExperiencePlease list your work experience for the past seven years beginning with your most recent job held. If you were self-employed, give firm name.
ReferencesPlease list two references other than relatives.
Other QualificationsSummarize job-related skills and qualifications acquired and/or professional, trade, business or civic activities and offices held. Please omit any information that would disclose your race, gender, age, marital status, ethnic origin, religious or political affiliations, or disability.
Gibbs & Register, Inc. is an equal employment opportunity employer. We adhere to a policy of making employment decisions without regard to race, color, religion, gender, sexual orientation, national origin, citizenship, age or disability. We assure you that your opportunity for employment with Gibbs & Register, Inc. depends solely on your qualifications
I certify that all information I have provided in order to apply for and secure work with the employer is true, complete and accurate.
I expressly authorize, without reservation, the employer, its representatives, employees or agents to contact and obtain information from all references (personal and professional), employers, public agencies, licensing authorities and educational institutions and to otherwise verify the accuracy of all information provided by me in this application, resume or job interview. I hereby waive any and all rights and claims I may have regarding the employer, its agents, employees or representatives, for seeking, gathering and using such information in the employment process and all other persons, corporations or organizations for furnishing such information about me.
I understand that this application remains current for only 150 days. At the conclusion of that time, if I have not heard from the employer and still wish to be considered for employment, it will be necessary to reapply and fill out a new application.
If I am hired, I understand that I am free to resign at any time, with or without cause and without prior notice, and the employer reserves the same right to terminate my employment at any time, with or without cause and without prior notice, except as may be required by law. This application does not constitute an agreement or contract for employment for any specified period of definite duration. I understand that no supervisor or representative of the employer is authorized to make any assurances to the contrary and that no implied, oral or written agreements contrary to the foregoing express language are valid unless they are in writing and signed by the employer’s president.
I also understand that if I am hired, I will be required to provide proof of identity and legal authority to work in the United States and that federal immigration laws require me to complete an I-9 form in this regard.
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 employer as they are currently constituted or may be changed from time to time.
DO NOT SIGN UNTIL YOU HAVE READ THE ABOVE APPLICANT STATEMENT.
I certify that I have read, fully understand and accept all terms of the foregoing Applicant Statement.
EMPLOYEE ACKNOWLEDGEMENT OF PROBATION
I understand that I am on Probation as an employee for the first 90-days of my employment for the purposes of the Florida “Unemployment Compensation Law”. I understand if my employer, Gibbs & Register, Inc. discharges me for unsatisfactory work performance under the Florida “Unemployment Compensation Law” he will not have his account charged for an employment benefits I might be determined eligible for in the future.
Drug-Testing Consent and Release
Pursuant to my application for employment, I understand that all job offers are expressly conditioned upon submitting to and passing a drug test to detect the presence of illegal drugs or alcohol use. I hereby consent to submit to a urinalysis or other tests as required by Gibbs & Register, Inc. for the purposes of testing for the presence of illegal drugs or alcohol abuse. I agree that a clinic or laboratory approved by the Florida Agency for Health Care Administration may collect and test any specimens I provide for these tests. I further agree to authorize the release of the results of these tests to the Medical Review Officer employed or retained by the Company, to the Drug-Free Administrator of the Company, and to such other management personnel as may require this information on a need to know basis. My understanding is that any information derived from these tests will be confidential between the laboratory, the Drug Free Administrator of the Company, and the Medical Review Officer, except as otherwise provided by law, or if I place the test or its results in issue in any administrative, legal or other proceeding.
I further agree to release and hold the Company and its agents, employees and assigns, including the laboratory collecting and conducting these tests, harmless from any liability arising in whole or in part out of the collection or testing of the specimens I provide or from the use of the information derived from these tests in consideration of my employment application.
I have carefully read this Consent and Release form and understand it completely. I also understand that execution of the Consent and Release is a condition of employment with Gibbs & Register, Inc./J. Register Co., Inc. and my refusal to sign will result in withdrawal of any offer of employment I may receive. I am signing this form voluntarily and have not been coerced nor placed under duress by any person.