Application Form

Name:

Address:

• Home Phone:
• Mobile Phone:
• Social Security #:
• Email Address:

• Referred By:
• Date Of Birth:
• Are you 18 Years of age or older? Yes No
• Do you have a valid Drivers License? Yes No
• Do you own reliable transportation? Yes No
• Are you a United States Citizen? Yes No
• Have you ever been convicted of a felony? Yes No

EMPLOYMENT DESIRED

• Position:
• Date you can Start:
• Salary Desired:

• Ever applied to this company before? Yes No
• Are you employed now? Yes No

• If so, may we inquire of your present employer? Yes No
• When?
• Where?

EDUCATIONAL BACKGROUND

• Did You Graduate? Yes No

• Last Year Completed: 1 2 3 4
• Did You Graduate? Yes No

• Last Year Completed: 1 2 3 4
• Did You Graduate? Yes No

• Last Year Completed: 1 2 3 4
• Did You Graduate? Yes No

GENERAL

Subjects of Special Study or Research Work:

Job Related Skill (typing, driver's license, equipment operation, safety council cards, etc, if have please advise office personnel to make copies):

Special Skills Or Experience:

FORMER EMPLOYERS

(List below your last four employers, starting with LAST one FIRST.)

REFERENCES

(List below three persons not related to you, whom you have known at least one year.)

Upon submission of this application, for consideration of employment, you are required to attest to your identity and employment eligibility, and to present documents confirming your identity and employment eligibility. It is the policy of TAP Industrial Services to have a valid state issued identification (driver's license, id, etc) and valid social security card. You cannot be hired if you cannot comply with these requirements.

AUTHORIZATION

I certify that the facts contained in this application (and accompanying resume, if any) are true and complete to the best of my knowledge, I understand that any false statement, omission, or misrepresentation on this application is sufficient cause for refusal to hire, or dismissal if I have been employed, no matter when discovered by the Company.

I understand that any employment is conditioned on a background check. I authorize the Company to thoroughly investigate all statements contained in my application or resume, and I authorize my former employers and references to disclose information regarding my former employment, character and general reputation to the Company, without giving me prior notice of such disclosure. In addition, I release the Company, any former employers and all references listed above from any and all claims, demands, or liabilities arising out of or related to such investigation or disclosure.

I understand and agree that nothing contained in this application, or conveyed during any interview, is intended to create an em ployment contract. I further understand and agree that if I am hired, my employment will be "at will" and without fixed term, and may be terminated at any time, with or without cause and without prior notice, at the option of either the Company or myself. No promises regarding employment have been made to me, and I understand that no such promise or guarantee is binding upon the Company unless made in writing.

If I am offered employment, I agree to submit to a medical examination and drug test before starting work. If employed, I also agree to submit to a medical examination or drug test at any time deem appropriate by the Company and as permitted by law. I consent to such examinations and tests, and I request that the examining doctor disclose to the Company the results of the examination. I understand that my employment or continued employment, to the extent permitted by law, is contingent upon satisfactory medical examinations and drug test, and if I am hired a condition of my employment will be that I abide by the Company's Drug and Alcohol Policy.

I understand that filling out this form does not indicate there is a position open and does not obligate the Company to hire. I agree to abide by all Company work rules, policies and procedures. The Company retains the right to revise its policies or procedures, in whole or in part, at any time. I agree to pay a $20 Cash Deposit for Drug Testing upon offer of employment.

I understand my application may be rejected due to missing information.

I have read and agree to authorization and policies contained in this employment application.