• Applicant Information

  • Answering 'yes' to the question regarding your criminal record does not constitute an automatic bar to employment. Among other things, we will consider the nature and gravity of the offense or conduct; the time that passed since the offense or conduct and/or completion of the sentence; and the nature of the job you are seeking. If you answer 'yes' to this question, be sure to provide an explanation.
  • Education

  • References

    Please list three persons not related to you, whom you have known at least 1 year, as references.
  • Previous Employment

  • Disclaimer and Signature

    I certify that the facts contained in this application are true and complete to the best of my knowledge and understand that, if employed, falsified statements on this application shall be grounds for dismissal. I authorize investigation of all statements contained herein and the references and employers listed above to give EnDyn any and all information concerning my previous employment and any pertinent information they may have, personal or otherwise, and release the company from all liability for any damage that may result from utilization of such information. I also understand and agree that no representative of the company has any authority to enter into any agreement for employment for any specified period of time, or to make any agreement contrary to the foregoing, unless it is in writing and signed by an authorized company representative. If necessary for employment, I may be required to: supply my birth certificate or other proof of authorization to work in the United States, have a physical examination and/or a drug test, or to sign a conflict of interest agreement and abide by its terms. I understand and agree to the information shown above. This waiver does not permit the release or use of disability-related or medical information in a manner prohibited by the Americans with Disabilities Act (ADA) and other relevant federal and state laws.

    (Please read and sign this form in the space provided below. Your written authorization is necessary for completion of the application process.)

    I, , hereby authorize EnDyn to investigate my background and qualifications for purposes of evaluating whether I am qualified for the position for which I am applying. This information may included but is not limited to, academic, residential, achievement, performance, attendance, personal history, disciplinary, arrest, and conviction records. I hereby direct you to release such information upon request of the bearer. I understand that the information released is for official use by EnDyn and may be disclosed to such third parties as necessary in the fulfillment of official responsibilities. I understand that EnDyn will utilize an outside firm or firms to assist it in checking such information, and I specifically authorize such an investigation by information services and outside entities of the company’s choice. I also understand that I may withhold my permission and that in such a case, no investigation will be done, and my application for employment will not be processed further. I hereby release any individual, including record custodians, from any and all liability for damages of whatever kind or nature which may at any time result to me on account of compliance, or any attempts to comply, with this authorization.


    In conjunction with my potential employment at EnDyn, I, , consent to the release of my Motor Vehicle Records (MVR) to the company. I understand the company will use these records to evaluate my suitability to fulfill driving duties that may be related to the position for which I am applying. I also consent to the review, evaluation, and other use of any MVR I may have provided to the company.

    This consent is given in satisfaction of Public I-aw 18 USC 2721et. Seq., *Federal Drivers Privacy Protection Act", and is intended to constitute "written consent" as required by this Act.


    I hereby agree, upon a request made under the drug/alcohol testing policy of EnDyn, to submit to a drug or alcohol test and to furnish a sample of my urine, breath, and/or blood for analysis. I understand and agree that if I at any time refuse to submit to a drug or alcohol test under company policy, or I otherwise fail to cooperate with the testing procedures, I will not be eligible for hire or will be subject to immediate termination. I further authorize and give full permission to have the Company and/or its company physician send the specimen or specimens so collected to a laboratory for a screening test for the presence of any prohibited substances under the policy, and for the laboratory or other testing facility to release any and all documentation relating to such test to the Company and/or any governmental entity involved in a legal proceeding or investigation connected with the test.

    I hereby consent to disclose, by EnDyn and its agents, including, but not limited to, collecting and testing agencies, of test results identified above and any related information to clients of EnDyn, its assigned agents and/or representatives. I understand that only duly-authorized Company officers, employees, and agents will have access to information furnished or obtained in connection with the test; that they will maintain and protect the confidentiality of such information to the greatest extent possible; and that they will share such information only to the extent necessary to make employment decisions and to respond to inquiries or notices from government entities.

    I will hold harmless the Company, its company physician, and any testing laboratory the Company might use, meaning that I will not sue or hold responsible such parties for any alleged harm to me that might result from such testing, including loss of employment or any other kind of adverse job action that might arise as a result of the drug or alcohol test, even if a Company or laboratory representative makes an error in the administration or analysis of the test or the reporting of the results. I will further hold harmless the Company, its company physician, and any testing laboratory the Company might use for any alleged harm to me that might result from the release or use of information or documentation relating to the drug or alcohol test, as long as the release or use of the information is within the scope of this policy and the procedures as explained in the paragraph above.

    This policy and authorization have been explained to me in a language I understand, and I have been told that if I have any questions about the test or the policy, they will be answered.

    All employees shall be subject to the following types of drug and alcohol testing: preemployment, reasonable suspicion, post accident, random, and return to duty.