Northern Bottling Company's Pre-Employment Affidavit

Equal Opportunity Employer

Northern Bottling Company is an equal employment employer. We pledge continued positive action to insure equal opportunity for all employees regardless of race, color, religion, natural origin, sex, age, or disability. It is our policy to provide employent opportunities to qualified disabled individuals, and veterans. By my signature and initials placed below, I promise that the information provided in this employment application is true and complete. I understand that any false information or significant omission may disqualify me from further consideration for employment, and may be justification for my dismissal from employment if discovered at a later date. I authorize the investigation of all statements contained in this application (and accompanying resume, if any). I agree to notify the company within 24 hours (for pending applicants) or at the beginning of my first shift after an incident if I should be convicted of a felony, or any crime innvolving dishonesty or breach of trust, or for arrest of a moving violation or upon conviction of a moving violation or such violation which could have been charged as such during my period of employment, if hired.

Required

External Disclosure

I authorize any person, school, current employer (except as previously noted), past employer, and organizations named in this application form to provide the company with relevant information and opinion that may be useful to the company in making a hiring decision, and I release such persons and organizations from any legal liability in making such statements.

Required

Driving Record

I give permission for a complete check of my driving record including any state where I presently have or have had a driver's license or permit.

Required

Physical Examination

I give permission for a complete employment physical examination, including a drug screening exam and x-rays. I consent to the release to the company of any and all medical information, as may be deemed necessary by the company in judging my capability to do the work in which I am applying.

Required
Required

Honesty & Integrity

I understand that if the company terminates my employment for dishonest, breach of trust, or any criminal acts the authorities may be notified and I may be criminally prosecuted. I also understand that, if hired, I may not hold other employment, nor engage in sales, investment or other activities that create a conflict of interest with my position.

Required
Required

At Will Employment

I understand that this aplication does not, by itself, create a contract of employment. I understand and agree that, if hired, my employment is for no definite period of time, and may, regardless of the date of payment of any wages or salary, be terminated at any time. This is "At Will Employment". I understand that no person is authorized to change any of the terms identified in this employment affidavit. Any verification made as a result of this release will be made in a professional manner by the general manager or at his/her request. Verifications will normally be made prior to job offer, after job offer and prior employment during evaluation period. Special conditions may require verifications during employment.

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Required

Position Details

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Address
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Post High School Education (list most recent)

Occupational License, Certificate, or Registration

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Work Experience

(List current or most recent first)

The Predictive Index® Organization Survey Checklist

Confirmation

I certify the information contained in this application is true, correct, and complete. I understand that if I become employed, false statements reported on this application may be considered sufficient cause for dismissal.

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Required