8. Personal Reference
Name:
Relationship:
Phone:
* Student Drivers: Referred by
**Choose One Please
Recruiter
Stevens Driver
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Website
Other
Name of Recruiter/Driver (if chosen above):
Other (if chosen above):
ACKNOWLEDGEMENT, AGREEMENT & RELEASE
I give Stevens Transportation, Inc. the right to investigate all references and to secure
additional information about me, if job-related. I release from liability
the Company and its representatives for seeking such information and all
other persons, corporations, or organization for furnishing such
information. A copy of this page serves as my authorization to
seek/provide this information. I agree to sign all documents and consent
forms which the Company deems necessary to verify the facts provided in
this application. I give my consent, and release from liability the
company and its representatives, to respond to any inquiries made about me
as part of a reference check by any subsequent or potential employer. I
authorize release of any information, including all information related to
my alcohol and controlled substance testing and training records conducted
under The Federal Highway Administration (FHWA) 49 CFR Parts 391 or 382,
by any past or current employers to Stevens Transport, Inc. I consent to
the procurement and use of any consumer reports, including reports from
DAC Services, Inc., deemed necessary by Stevens Transport, in their
consideration of my employment.
From time to time the Company may find it necessary to conduct investigations. If it does, employees are
expected to truthfully participate and cooperate in such investigations,
including submission to searches of property. Failure to do so may subject
employees to disciplinary action, which may include termination of
employment.
I realize as a condition of employment I will be required
to undergo a post offer/pre-employment medical examination and substance
abuse screening test as prescribed by the Company, and that any offer of
employment is conditioned upon the successful completion of these test. I
agree to furnish such additional information and undergo any other
examinations or tests to complete the employment file, or to continue my
employment with the company, If employed. These tests may include, but are
not necessarily limited to random, for cause, reasonable suspicion or
post-accident alcohol and substance abuse screening tests. Further, I
release the Company, its agents or employees from any and all claims or
actions arising out of such alcohol and substance abuse tests including,
but not limited to, the testing procedures, the analysis or the disclosure of test results.
I understand that any offer of employment is contingent upon my ability to produce documentation verifying my identity
and legal authorization to be employed, as required by the Immigration
Reform & Control Act of 1986 (IACA). This application is active for
sixty (60) days from the date it is completed, or until the specific
position opening for which it was submitted is closed, whichever is
earlier. Subsequent to the preceding consideration period. I must submit a
new application to be considered for this or any other position.
I understand and agree that any misrepresented, inaccurate, misleading,
incomplete or omitted information provided by me in this application will
be sufficient cause for cancellation of this application and/or separation
from the Company's service if employed. Further, I understand that just as
I am free to resign at any time, for any reason, with or without prior
notice, the Company reserves the right to terminate my employment at any
time, for any reason, with or without prior notice. I understand that no
representative of this Company has the authority to make any verbal or
written assurances to the contrary. I recognize the employment
relationship to be an at-will relationship and not for a specific period
of time. This application represents the complete and final expression or
the intent of the parties and may not be modified except by a writing duty
executed by the undersigned and an officer of the Company.
I hereby agree to submit to binding arbitration all disputes and claims arising out
of the submission of this or other formal application. I further agree, in
the event that I am offered employment by the company, as a condition of
that employment all disputes that cannot be resolved by informal internal
resolution which might arise out of submission of this application or out
of my employment with the company, whether before, during or after such
employment will be submitted to binding arbitration in lieu of any Federal
or State investigative, administrative, civil or other legal Proceeding. I
agree to such arbitration shall be conducted in accordance with the
Stevens Transport Alternative Dispute Resolution Program. A copy of The
Program is available at Stevens Transport for review, upon request.
I have read carefully the above information, understand and accept the
contents thereof. I certify that this application was completed by me, and
that all entries on it and information in it are true and complete to the best of my knowledge.
SIGNATURE: (please enter your name)
PLEASE PRESS "ACCEPT" ONLY ONCE TO SUBMIT YOUR APPLICATION!