Fillable Application For Employment (Page 4 of 4) in pdf

BACKGROUND INFORMATION

Applicants having sealed conviction records granted by court order may answer “no” to the following:

Have you been convicted of a misdemeanor?

Yes If yes, please explain below

(include charge, plea, date, disposition)

Have you ever been convicted of a felony?

Yes If yes, please explain below

(include charge, plea, date, disposition)

Have you ever been sued in a civil action for an intentional violation of the law?

Yes If yes, please explain below

*Note: Answering “Yes” to any of these questions does not necessarily disqualify you from the position you are applying for. Each action and

explanation will be considered in relationship to the position for which you are applying.

WAIVERS AND DISCLOSURES

Please read each section carefully and sign where indicated.

AT-WILL EMPLOYMENT

It is my understanding that this employment application, or the granting of an oral interview, does not represent a contract of employment

or a promise of future benefits by this organization. I understand and agree that, if hired, my employment will be at-will in nature and

may be terminated, with or without cause, at any time, by either myself or my employer. I also understand that this written statement

supersedes any and all oral representations made by agents or representatives of this organization.

CERTIFICATION OF TRUTH AND ACCURACY

I certify that the information in this application is true, complete and correct. I understand that false answers, statements, or significant

omissions made by me on this form shall be sufficient cause for denial of employment or discharge.

NOTIFICATION AND AUTHORIZATION TO REQUIRE A MEDICAL EXAMINATION

I hereby certify that, if hired, I will disclose any limitations I have that may impact my ability to do the job. I understand that I may also be

required to undergo a pre-employment or post-employment medical exam by a company designated health practitioner.

NOTIFICATION AND AUTHORIZATION TO CONDUCT BACKGROUND INVESTIGATION

I understand that I may be subject to a background check, and hereby authorize ACF Corporation, to investigate my background to

determine any and all information of concern as to my record, whether same is of record or not, and I release employers and all persons

named in my application from all liability for any damages on account of his/her furnishing said information.

Additionally, you are hereby authorized to make any investigation of my personal history, educational background, military record, motor

vehicle records, criminal records, and credit history through an investigative or credit agency or bureau of your choice. I authorize the

release of this information by the appropriate agencies to the investigating service. This authorization, in original or copy form, shall be

valid for this and for any future reports and updates that may be required.

I understand that passing the background check is a condition of employment. A negative background check can be grounds for

dismissal, even if an offer has been made to me and I have been hired.

PLEASE SIGN HERE:

Date

ACF Corporation is committed to the principle of equal opportunity and employment. ACF Corporation does not discriminate on the

basis of race, religion, color, national origin, age, sex, disability, sexual orientation, or veteran’s status. The following person has been

designated to handle inquiries regarding the company’s nondiscrimination policies:

Human Resources, 9311 Solar Drive, Tampa, FL 33619.

Revised July 2010

ACF Corporation

Application For Employment Page 4