Application for Employment

NATIONAL SIGNAL CORP.

NATIONAL SIGNAL MAINTENANCE CORP.

We will not discriminate based upon race, color, religion, sex, national origin, citizenship, age, height, weight, marital status, veteran status, handicap, or any other protected category. Individuals with disabilities may request accommodation in the application process.

Present Address

Permanent Address

*NOTE: A conviction record will not necessarily be a bar to employment. Factors such as age, time of offense, seriousness and nature of violation and rehabilitation will be considered. Nor will a dishonorable discharge from the military necessarily be a bar to employment.

Employment Desired

Education

High School

College

Other

List All Former and Current Employers Within the Past 10 Years.

If employed list first, then list all former employers with the most recent first.





References

List persons not related to you. Whom you have known at least one year.

Show Actual Experience by Checking the Following

Driving Experience

Answer the following question (s) only if the box next to the question is checked.

For each, please indicate




Disclosure

  1. I authorize the Company to make whatever inquires it may deem necessary in connection with my application for employment. As part of such inquires, the Company has my permission to contact person who may have information relating to my suitability for employment and to secure consumer reports (including investigative consumer reports).
  2. I authorize and instruct any person or agency contracted to participate or conduct inquiries at its request, to compile information, and to furnish any information obtained as a result of such inquiries whether or not such information is part of their records. I further authorize the Company, in its sole discretion, to furnish copies of this authorization and my application to any person(s) and/or consumer reporting agency(s) in connection with the above purposes. I agree to release you and all parties from any liability for any damages that may result from furnishing such information. Information contained in reports obtained by the Company in accordance with the above authorization may include information pertaining to your character, general reputation, police record, personal characteristics, and mode of living. You have the right to request that the Company completely and accurately disclose to you the nature and scope of all investigations requested. Such request must be made in writing to the personnel department within a reasonable period of time after your application for employment is received. If employment is denied on the basis of information contained in a credit report, the Company will advise you of its decision and provide the name and address of the credit-reporting agency that made the report.
  3. I certify that the information in this application is complete and correct to the best of my knowledge and understand that any falsification, misrepresentation, or omission of this information is ground for a rejection of this application or dismissal of any employment if I am hired.
  4. I authorize the Company to release any information requested by any of prospective or subsequent employers without any obligation to give me written notice of such disclosure and, in consideration of its efforts to provide information hereby release the Company and its agents from any liability whatsoever as a result of any such inquiries and disclosures.
  5. If employed, I understand that if I am or become handicapped in need of accommodations for employment, I must notify the President of the Company in writing within 182 days after the need is known.
  6. In consideration of my employment, I agree to confirm to the rules and regulations of the Company, and I agree that my employment and compensation can be terminated at any time with or without cause and with or without notice at the option of either the Company or myself. I understand that no officer or representative of the Company has the authority to enter into an agreement for employment for any specific period of time, or to make any agreement contrary to foregoing, except the President of the Company, and any such agreement must be made in a signed writing directed to me personally. I further acknowledge that no one has made any representations or statements contrary to the Company’s at-will policy to me, either orally or in writing, and I acknowledge and understand that no one has the authority to make such representations or statements to the contrary in the future.