Employment

Name*

First Last

Phone*

Email

Address

Street Address Address Line 2 City State ZIP Code

Are You At Least 18 Years Of Age Or Older?*

Yes
No

Are You Legally Authorized To Work In The United States?*

Yes
No

Do You Have A Valid Driver's License?

Yes
No

Driver's License Number

Driver's License Issuing State

Are You Willing To Travel?

Yes
No

Are You Fluent In Any Other Language Than English?

Yes
No

Have You Ever Been Convicted Of A Felony?

Yes
No

Available Start Date*

Certification*

I hereby certify that I have read, or had someone read, the above questions, and that I understand the questions asked and information requested. I hereby certify that the answers and information above provided is true to the best of my knowledge; and that I understand that false or misleading answers or information could result in the rejection of my application or my latter termination. Note: An employment offer will be conditional upon a negative drug/alcohol test result. Dynamic Rock Solutions’s Substance Abuse Policy considers all altered drug/alcohol-testing results as positive. Additional job-skills or performance related testing, including drug testing, may be required prior to employment.

I hereby agree to the above statement.

Release And Notification*

In accordance with the Privacy Act (5 U.S.C. 552a), Freedom of Information Act and the Fair Credit Reporting Act, I expressly authorize any person associated with any educational institution, past or present employer (including federal/state/local governments), any military organizations (federal or state), any law enforcement agency (federal/state/local), any credit reporting agency, or any person who has personal knowledge of my character, work history and overall mode of living to RELEASE this information to the background agency and or Dynamic Rock Solutions for the purpose of my being considered for employment. I hereby agree to RELEASE Dynamic Rock Solutions and any third party agencies acting on behalf of Dynamic Rock Solutions, their employees, agents and any other persons or other entities from any and all liability for damages of whatever kind or nature, whether known or unknown, which may at any time accrue to me on account of 1) reliance by such persons or entities on the information submitted in my employment application, 2) reliance by such persons or entities on the information obtained pursuant to this authorization, 3) compliance with or any attempt to comply with this authorization and 4) termination of my employment based on information obtained pursuant to this authorization.

I have read the above discolsure, and hereby authorize a consumer report and/or investigative report be obtained as described above. I also hereby authorize a copy of this RELEASE AND NOTIFICATION to be valid as the original.

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