APPLICATION FOR EMPLOYMENT

IMPORTANT: Read terms of employment carefully. Print or type answers to every question. All information on this form will be treated with confidentiality to the extent required by law. F.S. & GS. SERVICES, INC. is an equal opportunity employer and does not discriminate on the basis of RACE, COLOR, RELIGION, NATIONAL ORIGIN, AGE, GENDER, MARITAL STATUS, SEXUAL ORIENTATION (INCLUDING GENDER IDENTITY), MILITARY OR VETERAN STATUS, CITIZENSHIP STATUS, MENTAL OR PHYSICAL DISABILITY OR ANY OTHER CATEGORY PROTECTED BY LAW.

Name:______________________________________________________________________

LAST FIRST MIDDLE

Home Address:_______________________________________________________________

Street City State Zip

Mailing Address:______________________________________________________________

Street/P.O. Box City State Zip

Day Phone:____ Night Phone:

If you qualify for minority status, you may check one of the following (this is optional):

Black Asian/Pacific Islander Hispanic

Female American Indian Other (Specify)_______________

EMERGENCY CONTACT: Name:______________________________________________

Relationship:_________________ Day Phone:_______________ Night Phone:______________

Have you ever been convicted of violating any law except a traffic violation or released from prison within the last 10 years?: Yes No

If yes, attach a summary of details, date and type of conviction. Disclosure of a criminal record does not automatically disqualify you from employment consideration. Each case is judged on its own merits as it relates to the job for which you are applying.

EDUCATION: Please circle highest grade completed: 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16

Please list any other special training, skills, or certificates which would tell us more about your qualifications for the job for which you are applying: __________________________________________________________________________

EMPLOYMENT HISTORY

Have you ever worked for this company before? Yes No

If yes, LOCATION:____________________________________DATE(s):_________________

PLEASE LIST YOUR LAST THREE EMPLOYERS BELOW

EMPLOYER NAME	DATE OF HIRE	DATE OF TERMINATION AND REASON FOR TERMINATION

PERFORMANCE OF ESSENTIAL JOB FUNCTIONS

Can you perform the essential functions of the job for which you are applying, with or without a reasonable accommodation?

Are you or have you ever been a Preferred Worker? (Optional)

YES NO

If you suffered a disabling on the job injury and did not return to work with the employer of record after your recovery, you may be entitled to preferred worker benefits through the Department of Labor and Industries. If you are not sure whether you are eligible, please contact the Safety Director for assistance in processing your request. It is imperative that this information be reported to the Department at the time of hiring in order to receive full benefits from the program.

If hired, can you provide proof of a legal right to work in the United States? YES NO

MILITARY SERVICE:

Have you served in the United States Armed Forces? YES NO

If yes, please list the branch, dates of service, highest rank, and any education, training, or work experience in the United States Armed Forces which relates to the position for which you are applying:

_____________________________________________________________________________

DRUG AND ALCOHOL POLICY

This company is committed to providing a safe work place for all employees and to comply with Federal, State, and local laws regarding drug and alcohol testing. To meet this commitment, we have implemented a company drug and alcohol policy which includes: Pre-employment (post conditional employment offer), random, post accident, and for cause testing. If you have any questions concerning our policy; please contact the Safety Director.

PROFESSIONAL REFERENCES

Please provide a list of at least three (3) references (who are not related to you) who can be contacted for further information regarding your qualifications for the position for which you are applying:

1. ____________________________________________________________________

2.____________________________________________________________________

3.____________________________________________________________________

CERTIFICATION AND AGREEMENT – Please Read Carefully and Sign

I understand that, if hired, my employment with this company will be at-will and is not guaranteed for any term. I further understand that this means that my employment can be terminated at any time, for any reason or for no reason, without prior notice. I also understand and agree that labor and craft positions are all temporary employment of limited duration with expectations of layoff on or before completion of the project. I further understand that this at-will employment relationship can only be altered by a written agreement executed by an officer of the company. Finally, I understand that neither this application nor statements by representatives of F.S. & GS. Services, Inc. shall be deemed to constitute an employment contract, a promise or guarantee of employment for any duration, or a promise of specific treatment in specific circumstances.

I certify that all the information I have provided on this application and during the application process is true and correct. I am aware that should investigation at any time disclose any misrepresentation, omission, or falsification, my application may be rejected, my name may be removed from consideration, and/or I may be discharged from employment. I also acknowledge that, if hired, I will be required to abide by all policies, rules, and regulations of the company.

I authorize investigation of all statements contained in this application for employment and in the application process as the company deems necessary in arriving at an employment decision. I understand that, as part of the application process, the company may conduct a background investigation regarding my qualifications for employment to the extent determined appropriate. I authorize the company to solicit information regarding my character, general reputation, references, credit, criminal background, previous employment, work habits, education, and similar background information to be used as part of the procedures for processing my application for employment. I understand that if the company chooses to use a third party consumer reporting agency to obtain such information in a consumer report, I must sign a separate consent form.

I authorize the company to contact any and all references, my previous employers, and all schools and educational institutions which I have attended to provide it with any information regarding my current or former employment, scholastic records, or other relevant information. This includes my specific authorization for my previous employers to furnish the company, to the extent permitted by law, my reason for leaving, my performance history, and all other information they may have concerning my employment with them. I release all of my previous employers, educational institutions, credit agencies, and any other person or entity, as well as F.S. & GS. Services, Inc., from all claims, liabilities, and damages arising out of such investigations, the request for such information, or the furnishing of such information.