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Application for Employement

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Employee Information

Full name (Nombre) *

Email (Correo electrónico) *

Social Security# (Numero de geguro Social) *

Address (Direccion)

City (Ciudad)

State (Estado)

Zip (Codigo postal)

Phone (# de telefono)

Driving License# (# de Licencia valida)

Shirt Size (Talla de camisa)

Are you over the age of 18? (¿Usted tiene mas de 18 anos?)

Yes No

Are your eligible to work in the United States? (¿Es elegible para Irabojar en los E.U.?)

Yes No

Do you have proof of age?
(¿Tiene identificacioncon sue edad?)

Yes No

Have you been convicted of a felony in last 10 years? (¿Ha sido convicto por un delito grave en los ultimos 10 anos?)

Yes No

If yes, please explain (En easo afirrnativo, por favor explique)

Emergency Contact

Name (Nombre) *

Phone# (# de telefono) *

Relationship (Relacion)

Alternate# (Otro numero de telefono)

Address (direccion)

City (ciudad)

State (estado)

Zip (codigo postal)

I certify that the information on this form is true, complete and correct to the best of my knowledge. I understand that and fabrication or omission of information may cause my immediate dismissal, I agree that all statements made on this form may be investigated. I further understand that my employment is at will and agree that it is for no definite period and may be terminated. Neither the employer nor I have agreed to any specific period of employment or any specific pay or benefits that will set forth in a separate contract.

Toda la información esta cierta y compleja. Yo entiendo perfectamente que hay consecuencias si la información está falso o so omito algo, incluyendo la terminación de me trabajo. Me trabajo aquí es voluntariamenta y que no hay un contrato y podemos terminar su posición sin noticia. El empleador ni yo hemos hecho un contrato con la aumentación de mi paga.

Drug free work place policy (La politica del uso de drogas en el trabajo)

In order to maintain a drug free work place. 1 FIFTY ! Inc, does not allow the manufacture, sale, distribution, or possession and/or use of any controlled substance or illegal drugs. 1FIFTY 1 Inc. does not provide or make available any counseling or rehabilitation programs to employees. By signing this document, I. as an employee of 1 FIFTY 1 Inc.. agree to abide by these drug free work place policies and rules as a condition of employment.

Para obtener un lugar de trabajo sin drogay y alcohol, 1 FIFTY 1 Inc. no se permite la venda, el uso, o possession de drogas ilegales. 1 FIFTY 1 Inc. no ofrece programas de rehabilitacion o de consejo para los empleados. Cuando Firmo este papel, como empledo, de 1 FIFTY 1 Inc.. yo estoy de acuerdo con las reglas y la politica sobre el uso de drogas y alcohol como una parte de mi empleo.

Injury and Illness Prevention (Prevencion de lesiones y enfermendades)

This is the acknowledge there is a copy of the 1 FIFTY 1 Inc. Injury and Illness Prevention Program available at the Employee services. I understand that a violation of any rules or standards described in this guide, as well as those, may be published as additions in the future, could be reason for disciplinary action.

Yo se que hay una copia del programs de las hridas y las enfermendades y sus pervenciones en Employee Services. Y yo se que una violacion de este programa o de las reglas en la guia o de las que ponemos en el future, hay consequencias.

Refusal to undergo testing (La negative rotunda para la prueba de drogas)

I have read the Company's Substance Abuse Policy and I understand that I have the right to refuse to undergo drug testing. I also understand that if I refuse to undergo the testing, my position may be terminated or my application forfeited.
(Yo lei la politica de la compania sobre drogas y alcohol, y entiendo que tengo la decrecha a negarse todas las pruebas. Tambien, yo se que si no tomo la prueba, y soy un empleado. La compania puede terminar mi posicion.)

(Please Check) I refuse to undergo drug and alcohol testing. (Marque) Yo no puedo tomar la prueba de drogas ni alcohol.

Consent and Authorization Statment (Declaracion de la Autorizacion y Consentimiento)

I consent and agree to undergo drug and alcohol testing in accord with the Company's Substance Abuse Policy: that the company that collects my specimen and the testing laboratory that tests my specimen may communicate my test results and other information acquired in the testing process to the Company and its agents, representatives, and employees. I understand and agree that if my test result is confirmed positive and I am unable to timely and satisfactorily explain or rebut that result, my job offer will be withdrawn or, if I already have been hired. I will be subject to discipline up to and/or including immediate termination.

Con mi consiento, yo estoy de acuerdo con la prueba de drogas y alcohol con la politica de 1 FIFTY 1 Inc. sobre el usode alcohol y drogas. Yo se que la compania que toma mi specimen puede darle a un laboratorio, la compania puede comunicarse con la representica, y los empleados sobre los resultados de la prueba. Yo se, si mi prueba es positive, yo puedo rebutir el result con una explicacion y puedo tomor mas pruebas extentivas. Las Consequencias de una prueba positive es la terminacion de mi trabajo.