HRH Employment Application Form

HRH Labor Services, LLC - Employment Application
By completing this application, you understand and accept that you are applying for a position as an "At Will" employee. "At Will" employment means that either you or the Company can terminate your employment with or without cause and with or without notice.

~NOTE - All positions are for "On Call" only, no Full-Time or Part-Time positions implied~
Name: *

First Name Middle Initial Last Name Suffix
Other Names by which you have been known (if any)

First Name Middle Initial Last Name
Address: *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
Birth Date *

Month Day Year
Home Phone

Area Code Phone Number
Mobile Phone *

Area Code Phone Number
E-mail Address:
Emergency Contact *

Name Phone Relationship
Relatives Currently or Formerly Employed at Company
First Name Middle Initial Last Name
First Name Middle Initial Last Name

Employment History

Start with your current or most recent employer and work backwards regarding all former employers.
Current or Most Recent Employer: *
Name of Employer
Address
City, State, Zip
Last Position You Held:
Immediate Supervisor(s)
Phone Number(s)
Dates of Employment Most Recent Salary or Hourly Rate
Job Title and Responsibilities
Hours worked per Week Reason for Leaving
May we Contact this Employer? *
Next Recent Employer:
Name of Employer
Address
City, State, Zip
Last Position You Held:
Immediate Supervisor(s)
Phone Number(s)
Dates of Employment Most Recent Salary or Hourly Rate
Job Title and Responsibilities
Hours worked per Week Reason for Leaving
May we Contact this Employer?
Next Recent Employer:
Name of Employer
Address
City, State, Zip
Last Position You Held:
Immediate Supervisor(s)
Phone Number(s)
Dates of Employment Most Recent Salary or Hourly Rate
Job Title and Responsibilities
Hours worked per Week Reason for Leaving
May we Contact this Employer?
References

Please list two references that are familiar with your work life.
Reference 1
Name:

First Name Last Name
Phone Number

Area Code Phone Number
Years Known:
Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
Click to edit
Reference 2
Name:

First Name Last Name
Phone Number

Area Code Phone Number
Years Known:
Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
Are you a member of a Federally recognized Indian Tribe or Alaskan Native Group?
If you answered yes, please list the tribe or group:
Are you enrolled or a descendant?

1. Can you provide proof of eligibility to become employed in the United States? *
If no on #1, are you able to provide such proof which will be required upon employment if you are offered a position?
2. If you are under the age of 18, can you provide required proof of your eligibility to work? *
3. Have you ever filed an application for employment with us before? *
If Yes, set forth dates of your application:
Date

Month Day Year
4. Are you currently employed? *
If currently employed and you do not wish for us to contact your employer, please set forth the reasons why:
5. Are you currently on layoff status and subject to recall? *
6. Do you have adequate transportation to meet travel requirements of the job? *
7. Do you have a current valid drivers license? *
If yes, please state the following:
Issuing State Expiration Date
8. Are you able and willing to travel for this job if travel is necessary? *
9. Are you aware of any reason that may restrict your ability to perform the essential functions of the job for which you are making application? *
If yes, please explain and describe what accommodations might be necessary:
10. Have you ever been terminated or forced to resign from your employment with any employer? *
If yes, please explain:
11. Have you ever been denied a security clearance? *
If yes, please explain including the employer for whom the security clearance was denied, the date on which such security clearance was denied and the reason that such security clearance was denied:
12. Have you ever been convicted of a crime including any driving and/or alcohol related offenses? *
If yes, please explain:

Company Policies
DISPATCH PROCEDURES

IMPORTANT: Read Carefully as you are waiving certain rights

1. I understand that I am not required to work on any particular day and whether I report to a local HRH Labor Services,

LLC office is solely my choice. If I wish to be considered for work, I will visit a local office and sign in. I know that

HRH Labor Services, LLC is not required to find work for me, and is not required to contact me in any way or to make

work available to me. HRH Labor Services, LLC may assume I am not available for work on any day I do not visit a

local office and sign in.

2. I understand that after receiving a job assignment, I am free on my own time to leave a local office and do as I wish

until the job assignment starts. I will not be paid except for hours on the job assignment. I understand the importance

of never being late for a job assignment.

3. If I have Repeat Ticket (are request to return to the same job at a later date or time), I know that I must report may availability to the local HRH

Labor Services, LLC office at least two (2) hours before the schedule start time and that ifI do not, then HRH Labor Services, LLC may assume I am not

available to return to the job assignment and my fill therequest with another worker.

4. I understand that my employment with HRH Labor Services, LLC is on a day to day basis. At the end of each day I will be deemed to have quit

unless and until I request and receive a work assignment at a later date or time. I also understand that by accepting temporary assignments I am

giving up my right to file for unemployment since I understand and agree that I voluntarily quit after each daily assignment and "Lack of work" is not

the reason for my departure.

ARBITRATION

IMPORTANT: READ CAREFULLY. YOU ARE WAIVING CERTAIN RIGHTS

AND AGREEING TO SUBMIT DISPUTES TO ARBITRATION

I agree that any disputes arising out of my application for employment or my employment with HRH Labor Services, LLC

including any claims of discrimination, harassment, or wrongful termination, and all other employment related issues

(excluding only those which by law are not subject to arbitration) shall be resolved by arbitration as my sole remedy. This

arbitration shall be conducted by the American Arbitration Association under its commercial arbitration rules and the decision

of the arbitrator shall be final and binding. I understand that HRH Labor Services, LLC also agrees to arbitrate in the same

manner any claims that the company believes it has against me.

DRUG FREE JOB ASSIGNMENT

Some job assignments require that all workers assigned undergo drug testing. If you

wish to participate in HRH Labor Services, LLC "Drug Free Certification Program" under the conditions outlined in our "Policy

of Drugs and Testing" which is available on request. If you chose not to participate you will still be eligible for

assignments that do not.

CONSENT TO DRUG/ALCOHOL TESTING IN THE EVENT OF WORK-RELATED INJURY OR ILLNESS

I understand that HRH Labor Services, LLC requires any employee who suffers a work-related injury or illness to be tested

for drugs and/or alcohol. This testing is to be done at the location where initial treatment for the injury or illness is provided,

and is to conducted in accordance with accepted medical procedures. I understand that if I refuse to submit for testing, it

will be considering as refusal to comply with a reasonable request from my employer and will cause for dismissal. I further

agree to hold harmless HRH Labor Services, LLC, its principles, agents, customers, employees, and officers for nay and

all consequences arising from my testing positive for the use and/or influence of drugs or alcohol at the time of my injury or

illness.

RELEASE OF CLAIMS AGAINST HRH LABOR SERVICES CUSTOMERS

I am a temporary worker for, or am applying for temporary work assignments with, HRH Labor Services, LLC.

I understand that HRH Labor Services, LLC provides temporary workers for its customer to work at customers' project sites.

In accepting any work assignment, I acknowledge that I am a temporary employee of HRH Labor Services, LLC and am not

an employee of HRH Labor Services, LLC customer.

If I am ever injured in the course of my work for HRH Labor Services, LLC, I agree that I will only look at HRH Labor

Services, LLC Workers' Compensation coverage and not to HRH Labor Services, LLC customer(s) for any recovery or

damages. On behalf of myself, my heirs, executor, personal representatives, assigns, and agents, I hereby waive, release

and forever discharge any claim that I may now have or that may later accrue against any HRH Labor Services, LLC

customer, their employees, officers, directors, or agents, which arises, directly or indirectly, out of any injuries which may

occur to me while on a temporary work assignments for HRH Labor Services, LLC.

In signing this release I understand I am not waiving or releasing any claims I may have or which may accrue against the

workers compensation coverage provided by HRH Labor Services, LLC.
By typing your name in the box below and checking the acceptance box you agree that you have read and fully understand the above policy *
You must accept all Company Policies to proceed with the application process *

Accept Policies
By Submitting this application I understand that the Company requires its employees to adhere to the highest standards of business and personal ethics and responsibility. I understand that the Company believes that one method by which such high standards are demonstrated is through the timely meeting of financial obligations. Consequently, I understand and agree that by making application for a position with this company, I am agreeing that my credit worthiness is substantially related to the job for which I am applying or which I hold and that my credit worthiness may be examined by the company.

I further understand and agree that this application is not a contract of employment. I understand and agree that the Company adhere to a policy of employment at will which means that either I, or the employer, may terminate my employment at any time, or for any reason, consistent with application of state and federal law. I further understand that this "at will" employment relationship may not be changed by any written document or by conduct unless such change is in a written employment contract naming me and signed by the President of the Company. I understand that to be employed, I must be lawfully authorized to work in the United States and must show the employer documents to prove this.

I understand that the Company may investigate my work, personal, and criminal history and verify the information provided in this application, on related documents or information obtained through other sources and I hereby authorize such investigation. I authorize all individuals, schools, firms and business named in this application or in other documents or interviews, except my current employer if I have so designated in this application, to provide complete and accurate information regarding my relationship with them to the Company. I further release those individuals, schools, firms and business and the Company from any and all liability for damage for providing or requesting such information.

I certify under penalty of perjury that all of the information provided in the entire application process including any information provided in addition to this application including, but not limited to, information provided in resumes or interviews is true and correct. I understand that if there is any falsification or omission, this may lead to the Company’s refusal to hire me or a determination, at any time, that my employment should be terminated.

The Company is an Equal Employment Opportunity Employer and considers all applicants without regard to race, color, religion, gender, national origin, age, marital status, veteran’s status, the presence of a mental, physical or sensory disability, sexual orientation, or any other legally protected status. Employment shall be based solely on the needs of the companies and the qualifications of the individuals making application.
Should be Empty:

HRH Labor Services, LLC - Employment Application

By completing this application, you understand and accept that you are applying for a position as an "At Will" employee. "At Will" employment means that either you or the Company can terminate your employment with or without cause and with or without notice.

Relatives Currently or Formerly Employed at Company

Employment History

References

Reference 1

Reference 2

Skills and Certifications

Company Policies