Application for Employment

REFERENCES (list three professional references who are not relatives)

Reference 1 Name *

Address *

Business Relationship *

Telephone *

Years Known *

Reference 2 Name *

Address *

Business Relationship *

Telephone *

Years Known *

Reference 3 Name *

Address *

Business Relationship *

Telephone *

Years Known *

List any comments you may wish to make regarding this application. Omit comments which indicate race, religion, national origin, color or sex. *

APPLICANT'S AUTHORIZATION (read carefully before signing)

A physical examination is required of all job applicants to verify fitness to work after a job offer is extended but prior to beginning work. The result of such an examination will not be used to disqualify an applicant except to the extent that any disability discovered would, even with reasonable accommodation, preclude the safe, adequate performance of the job in question.

The above information is complete and true to the best of my knowledge. I understand that discovery of misrepresentation or omission of facts herein may result in immediate dismissal.

I understand that in making this application for employment, Poly Plastic Products or any agent acting on its behalf may request an investigative consumer report containing information obtained through personal interviews with third parties such as neighbors, friends, business associates, financial sources, and acquaintances. The inquiry information as to character, general reputation, personal characteristics and mode of living, whichever may be applicable.

I further understand that I have the right to make a written request within a reasonable period of time to receive additional detailed information about the nature and scope of the investigation.

I authorize all persons, schools, companies, corporations, law enforcement agencies and credit bureaus to release any information concerning my background, and I hereby release them from any and all claims of liability in law and in equity that may arise out of obtaining such information.

I understand that this statement does not constitute an employment contract between Poly Plastic Products and me, and that my employment is for no fixed duration and can be terminated at any time with or without notice or cause for any reason not otherwise prohibited by law.

Date

Digital Signature *

THIS APPLICATION WILL BE CONSIDERED FOR TWO MONTHS FROM THE DATE IT IS SUBMITTED. SHOULD YOU WISH TO BE CONSIDERED FOR EMPLOYMENT AFTER THIS DATE, YOU MUST SUBMIT A NEW APPLICATION.