Albany Industries

APPLICATION CERTIFICATION AND AGREEMENT

As Part of its ongoing program to select the best candidates for employment adn to provide a safe and healthy place of employment for its employees, I understand that Albany Industries may do post accident testing for drugs and alcohol.

If hired, I consent to post accident drug and alcohol testing and I further consent to searches of areas on Company premises, including but not limited to lockers, lunchboxes, briefcases, parking lots, and automobiles.

I understand that the results of any such drug screening test will be considered in my continued employment with Albany Industries.

I hereby consent to drug or alcohol screens, including, but not limited to, a urine test and/or blood test, and to a disclosure of the results of the test to the Company for its use and internal communication. I hereby release and fully and forever discharge the Company and any laboratory or facility which performs analysis from any claim or liability arising from such testing including, but not limited to, the testing procedure, the analysis, the accuracy of the analysis or the disclosure of its results.

I understand that the drug or alcohol screens may pick up the presence of prescription drugs and that it is important for me to disclose any prescription drugs which I am using , or which I have recently, prior to the screening test being conducted. I authorize the Company to contact the physicians which prescribed the medication reported by me and I hereby authorize the physician to provide information to the company regarding the reason for such prescription and information regarding its effect or potential effect on my performance.

I hereby state that I have answered accurately all the questions of the foregoing form. I realize taht any inaccurate or false answers may be grounds for denying employment or terminating my employment should I be hired.
       
I agree to the terms above:
   

EMPLOYMENT APPLICATION
*This application will be given active consideration for 30 days. Please renew it after that time.
Position:
JobNumber:
Date:
 9/8/2008
Years Experience:
Last Name:
First Name:
Middle Name:
SSN:
Address:
Phone:
  
Are you presently employed?
May we contact your present employer?
Date Available to start work:
Are you currently on layoff status and subject to recall?
Have you been convicted of a felony within the last seven years?
Are you prevented from lawfully becoming employed in this country because of a visa or immigration status?
OTHER INFORMATION
       
Spouse Name: Where Employed:
       
List Relatives Employed By Us   List Close Friends Employed By Us
Name: Relationship: Name:
Name: Relationship: Name:
Name: Relationship: Name:
EDUCATION
       
   
Highest Grade Completed
Name of School
Location
Year Left School
Graduated?
  Grade School:

  High School:
  College:
  Trade School:
MILITARY STATUS
Present Draft Classification:   Member of Reserves?   Member of National Guard?  
PREVIOUSE EMPLOYERS
Cover all Prior Employment
Dates
Description of Job
Last Rate of Pay
Reason for Leaving
Immediate Supervisor
List Most Recent First
From
To
Name:
 
 
Location:
Phone:
 
 
Name:
 
 
Location:
Phone:
 
 
Name:
 
 
Location:
Phone:
 
 
Name:
 
 
Location:
Phone:
 
 
               

REFERENCES
(Not Relatives)
Name
Address
Phone
Years Acquainted
Reference1:
Reference2:
Reference3:
 
Disclaimer
 

*We are an Equal Opportunity Employer. Federal Law prohibits discrimination in employment practices because of age (with respect to individuals who are at least 40 or older), race, color, religion, sex, national origin, or disability. Facts relating to your age, race, color, sex, national origin, or disability are not considered in determining your qualifications for employment.

I understand that any false or misleading information or omissions in this application shall be sufficient cause for rejection or immediate dismissal. I authorize you to contact my former employers about my employment record. The use of this blank does not indicate there are positions open and does not in any way obligate the company. If employed, I agree to abide by and observe all company rules and policies. I also understand and agree that, if hired, my employment is for no definite period and may be terminated with or without cause, at any time, at the option of the company and myself.
       
I have read and agree to the disclaimer above: Date: