APPLY

IR Staffing

DISCLOSURE TO OBTAIN

CONSUMER REPORTS FOR EMPLOYMENT PURPOSES

Please Read Carefully Before Signing the Authorization

In considering you for employment and, if you are employed, in considering you for subsequent

promotion, assignment, reassignment, retention, or discipline, IR Staffing ("the Company") may

request and rely upon one or more consumer reports or investigative consumer reports about you

that we obtain from a consumer reporting agency such as federal, state, county, municipality

agencies, and civil records available for scrutiny for employment purposes.

For explanation purposes :

--a "consumer report" is a written, oral, or other communication of any information by a

consumer reporting agency bearing on your credit worthiness, credit standing, credit capacity,

character, general reputation, personal characteristics, or mode of living which is used or

expected to be used or collected in whole or in part for the purpose of serving as a factor in

making an employment-related decision about you. Such information may include, for example,

credit information, criminal history reports, or driving records; and


--an "investigative consumer report" is a consumer report in which information on your

character, general reputation, personal characteristics, or mode of living is obtained through

personal interviews with your prior employers, neighbors, friends, or associates, or with others

who may have knowledge concerning any such items of information. In the event an

investigative consumer report is requested about you, you are entitled to additional disclosures

regarding the nature and scope of the investigation requested, as well as a written summary of

your rights under the Fair Credit Reporting Act ("FCRA").


Under the FCRA, before the Company can obtain a consumer report or investigative consumer

report about you for employment purposes, we must have your written authorization. Before we

take adverse action on the basis, in whole or in part, of information in that report, you will be

provided a copy of that report, the name, address, and telephone number of the consumer

reporting agency, and a summary of your rights under the FCRA.

AUTHORIZATION:

I have read and understand the foregoing Disclosure, and authorize IR Staffing to obtain and rely

upon consumer reports or investigative consumer reports in considering me for employment and,

if I am employed, in considering me for subsequent promotion, assignment, reassignment,

retention, or discipline. By my signature below, I authorizethe Company to obtain any such

reports and to share the information received with any person involved in the employment

decision about me.

I do

do not

authorize you to contact my current employer for Employment and Reference verifications.


(This will authorize immediate inquiries to the Human Resources Department and to any listed supervisors or references in the Employment/Reference Section of your application.)


I also agree that this Disclosure and Authorization in original, faxed, photocopied, or electronic (including electronically signed) form will be valid for any consumer reports or investigative consumer reports that may be requested about me by or on behalf of the Company

Personal Data to Obtain Background Information:

I have the right to make a request to the Company, upon proper identification, to request the nature and substance of all information in its files on me at the time of my request, including sources of information, and the recipients of any reports on me which the Company has previously furnished within the two-year period preceding my request.


I certify that all elements of the personal data I have provided are true, accurate, and complete. I understand and agree that any omission, false statement, misleading statement, or answer made by me on my application or any supplements to it and in any interviews will be sufficient grounds for rejection of employment or my discharge after employment.

IR Staffing

IR STAFFING

8836 Gall Blvd.

Zephyrhills, FL 33541

Ph: 813-788-4011

Fax: 1-888-907-1743

www.irstaffing.us

Your hiring packet is shared with our payroll company, Encore Enterprises HR. This includes the following forms: Employee PayrollA{ew Hire Data, Terms and Conditions, W4 form, I-9 form, Employee Request for Direct Deposit or Paycard, and Payroll Deduction Authorization form.


In considering you for work assignments with IR Staffing, your resume will be sent to our customers.


If you are a worker running heavy equipment in a warehouse (examples: forklift, reach, crane, etc.), running outdoor equipment, or driving non-CDL company vehicles, we will share with the customer a copy of your driver's license and a current motor vehicle report of the last 7 years.


By signing below, you are giving us permission/authorization, and consenting to allow us to e-mail or otherwise provide or disclose the above-mentioned paperwork to the appropriate company.

IR Staffing


Application For Employment

Please Print

Confidential


Equal access to programs, services, and employment is available to all persons. Those applicants requiring reasonable accommodation to the application and/or interview process should notify a representative of the Human Resources Dept.

General Information

Address 

IF YOU ARE SEEKING WORK IN, OR LIVE IN, ANY OF THE FOLLOWING STATES/DISTRICTS, DO NOT COMPLETE THE FOLLOWING CRIMINAL HISTORY QUESTIONS AT THIS TIME: DC, HI, IL, MA, MN, NJ, or RI.


Note: Answering “yes” to any of the following questions does not constitute an automatic bar to employment. Factors such as date of the offense, seriousness and nature of the violation, rehabilitation, and job applied for will be taken into account. In answering these questions, do not include any of the following: 1) minor traffic infractions, 2) convictions that have been judicially dismissed or ordered sealed, expunged, or statutorily eradicated, 3) any conviction for which probation has been successfully completed or otherwise discharged and the case has been judicially dismissed, or 4) referrals to, and participation in, any pre-trial or post-trial diversion programs.


Educational Background

Starting with your most recent school attended, provide the following information


Please fill this section (and the next page as needed), even if you have a Resume.

Employment History

Starting with your most recent employer, provide the following information.

Address 

Dates Employed

Address 

Dates Employed

Address 

Dates Employed

Office Skills (if applicable)


Please check all of the applicable office skills. Include software titles and the number of years of experience or other detailed information for each.

Craft / Warehouse Skills (if applicable)

Please check all of the applicable craft / warehouse skills. Include additional information and the number of years of experience for each.

Other Information

Exclude information that would reveal race, color, religion, sex, national origin, genetic information, citizenship, age, mental or physical disabilities, veteran/reserve/national guard, or any other similarly protected status.

References

List names and telephone numbers of three business/work references such as previous supervisors who are not related to you. If not applicable, list three school or personal references who are not related to you.


Related Information

Exclude information that would reveal race, color, religion, sex, national origin, genetic information, citizenship, age, mental or physical disabilities, veteran/reserve/national guard, or any other similarly protected status.

Applicant Statement

1. I certify that all information I have provided in order to apply for and secure work with this employer is true, complete, and correct. I understand that any information provided by me that is found to be false, incomplete, or misrepresented in any respect, will be sufficient cause to (a) eliminate me from further consideration for employment, or (b) may result in my immediate discharge from the employer’s service, whenever it is discovered.


2. I expressly authorize, without reservation, the employer, its representatives, employees, or agents to contact and obtain information from all references (personal and professional), employers, public agencies, licensing authorities, and educational institutions, and to otherwise verify the accuracy of all information provided by me in this application, resume, or job interview. I hereby waive any and all rights and claims I may have regarding the employer, its agents, employees, or representatives, for seeking, gathering, and using truthful and non-defamatory information, in a lawful manner, in the employment process, and all other persons, corporations, or organizations for furnishing such information about me.


3. I understand that this employer does not unlawfully discriminate in employment and no question on this application is used for the purpose of limiting or eliminating any applicant from consideration for employment on any basis prohibited by applicable local, state, or federal law.


4. I understand that this application remains current for only 30 days. At the conclusion of that time, if I have not heard from the employer and still wish to be considered for employment, it will be necessary for me to reapply and fill out a new application.


5. If I am hired, I understand that I am free to resign at any time, with or without cause and with or without prior notice, and the employer reserves the same right to terminate my employment at any time, with or without cause and with or without prior notice, except as may be required by law. This application does not constitute an agreement or contract for employment for any specified period or definite duration. I understand that no supervisor or representative of the employer is authorized to make any assurances to the contrary and that no implied oral or written agreements contrary to the foregoing express language are valid unless they are in writing and signed by the employer’s president.


6. I also understand that if I am hired, I will be required to provide proof of identity and legal authorization to work in the United States and that federal immigration laws require me to complete an I-9 Form in this regard. Further, this Company participates in the E-Verify program.


7. This Company does not tolerate discrimination in its employment practices. No question on this application is used for the purpose of limiting or excluding an applicant from consideration for employment on the basis of his or her sex, race, color, religion, national origin, genetic information, citizenship, age, disability, marital status, veteran status, sexual orientation, or any other protected status under applicable federal, state, or local law. This Company likewise does not tolerate harassment based on sex, race, color, religion, national origin, genetic information, citizenship, age, disability, marital status, veteran status, sexual orientation, or any other protected status. Examples of prohibited harassment include, but are not limited to, unwelcome physical contact, offensive gestures, unwelcome comments, jokes, epithets, threats, insults, name-calling, negative stereotyping, possession or display of derogatory pictures or other graphic materials, and any other words or conduct that demean, stigmatize, intimidate, or single out a person because of his or her membership in a protected category. Harassment of our employees is strictly prohibited, whether it is committed by a manager, coworker, subordinate, or non-employee (such as a vendor or customer). The Company takes all complaints of harassment seriously and all complaints will be investigated promptly and thoroughly.

DO NOT SIGN UNTIL YOU HAVE READ THE ABOVE APPLICANT STATEMENT.

I certify that I have read, fully understand, and accept all terms of the foregoing Applicant Statement.

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