|I certify that the statements I have made to StaffSource, Inc. are true and correct and without material omission. I understand that making false statements or omitting pertinent facts is sufficient cause for rejection or dismissal from employment. I authorize StaffSource, Inc. to obtain information from any person(s), employers, educational institutions, licensing authorities, and/or law enforcement agencies concerning my background, work habits, skill or conduct on the job, with the exception of past employer(s) I have indicated that are not to be contacted. I hereby release such person or entities from all liability for damages for issuing such information.
When I am employed by StaffSource, Inc. I agree that if at any time I make claims against Bolt Staffing Service, Inc. for personal injuries, I will submit myself, upon written request, to examination by a physician or physicians of StaffSource’s selection, at StaffSource’s expense, as often as may be requested.
I also agree that if I am employed by StaffSource, Inc., now or at any time in the future, my employment may be terminated by Bolt Staffing Service, Inc. at any time without liability to me for wages or salary except for such wages or salary which I earned prior to the date of my termination.
I agree that I have been informed of the requirements of the work for which I am applying, and that the information on this application is correct and complete to the best of my knowledge. I understand that it shall be grounds for my immediate dismissal if any of the information contained herein is found to be untrue. I authorize you and all former employers given by me as references, to answer all questions and to give all information in connection with this application or in any way concerning me.
I understand that if accepted for employment, I will be working for you on your payroll, at your client’s premises. I agree that I will obtain your permission before discussing direct employment with your client. I agree to immediately notify you at the conclusion of each assignment or as soon as I become available. If I fail to give such notice, you may assume that I am not available for re-assignment, and am not ready willing and able to work. I understand that any information I learn while working for a client is to be kept confidential. I will hold you harmless from any claims including, but not limited to, personal injury or illness as a result of my providing false or misleading information on this application. I hereby acknowledge that my employment is “at will”, that I may resign at any time and the company may terminate my employment at any time, with or without cause. Accordingly, I agree that, while the employment relationship continues, I will be paid in accordance with the regular payday rules governing current employees. I will be paid on regular paydays following the completion of services on any temporary assignment. If I expressly notify you of my decision to quit, or if I am terminated, I will receive my final wages sooner, as the law requires.
Please take a moment to review your application. Indicate that you have read the above statement by entering your initials in the box below. To complete this application, click on the Submit Application button.