Win-Tech Job Application: Pre-Interview -

Name *

First

Last

Email *

Phone *

Address *

Address Line 1

Address Line 2

City

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Zip Code

What open job are you applying to? (select one) *

AFFIRMATIVE ACTION QUESTIONNAIRE (OPTIONAL):

Win-Tech, Inc. is an Equal Employment Opportunity employer. The Company believes in and practices equal employment opportunity for all applicants, based upon their training, experience and overall qualifications. To insure this philosophy and practice, Company policy prohibits unlawful discrimination based upon an individual’s race; color; creed; sex; religion; marital status; age; national origin or ancestry; physical or mental disability; pregnancy; childbirth or related conditions; handicap; medical condition; veteran status or any other consideration protected by federal, state or local law, ordinance or regulation. We ask you to voluntarily provide us with the following information to assist us in complying with government reporting requirements under the Equal Employment Opportunity Act. Completion of this form is purely voluntary and will not, in any way, affect your consideration for employment. This completed form will be maintained in a confidential manner and filed separately from your application.

Sex:

Female
Male

Race:

American Indian or Alaskan Native – All persons having origins in any of the original peoples of North America, and who maintain cultural identification through tribal affiliation or community recognition.
Asian or Pacific Islander – All persons having origins in any of the original peoples of the Far East, Southeast Asia, the Indian Subcontinent, or the Pacific Islands. This area includes, for example, China, India, Japan, Korea, The Philippine Islands, and Samoa.
Black – (Not of Hispanic origin) – All persons having origins in any of the Black racial groups of Africa.
Hispanic – All persons of Mexican, Puerto Rican, Cuban, Central or South American, or other Spanish culture or origin, regardless of race.
White – (Not of Hispanic origin) – All persons having origins in any of the original peoples of Europe, North Africa or the Middle East.

APPLICANT INFORMATION RELEASE:

READ AND ACKNOWLEDGE *

I agree (type name and date below)

I hereby authorize Win-Tech, Inc. and/or any of its authorized agents to gather information regarding the following: • All records including criminal, credit, driving (where required by position), and education. • Information from previous employers whether contained in written records or not. • Any other pertinent information relating to the successful function of my job. I hereby release Win-Tech, Inc. and its employees, former employees, other references and any of its authorized agents from any liability, and understand there is no invasion of personal privacy. I understand a background profile verification will be conducted in order to ensure the business standards and practices of Win-Tech, Inc. and that the contents of this investigation will be kept confidential. If I am employed with Win-Tech, Inc., I authorize the reinvestigation of any of the above information, at any time, during my term of employment. I understand that any offer of employment is contingent on a satisfactory background investigation. I also understand that this form is requested for identification purposes only and will not be kept in my permanent file if I am employed. I certify that the following is my true and complete legal name and all information contained herein is true and correct to the best of my knowledge.

Name *

First

Middle

Last

Today's Date *

Layout

Drivers License Number *

Date of Birth *

State of Issue *

Social Security Number *

GEORGIA CRIMINAL HISTORY CONSENT:

I hereby authorize Win-Tech, Inc. to receive any criminal history record information pertaining to me, which may be in the files of the state or any local criminal justice agency within the state of Georgia. I understand that Win-Tech may authorize ADP Screening and Selection Services, Inc. Ft Collins to receive this information.

Check here to acknowledge/agree. *

I agree

CONSENT TO DRUG AND ALCOHOL TESTING (PRE-EMPLOYMENT):

I hereby consent to submit to the testing for drugs and/or alcohol as shall be determined by Win-Tech, Inc. in the selection process of applicants for employment, for the purpose of determining the drug and/or alcohol content thereof. I agree that Quest Diagnostics may collect these specimens for these tests and may test them, if qualified, or forward them to a licensed or certified laboratory designated by the company for analysis. I further agree to and hereby authorize the release of said test results to the company. I understand that I may be responsible for the cost of this pre-employment test at a local Quest Diagnostics location (approximately $20.00). I understand that my current use of illegal drugs may prohibit me from being employed at this Company. I further agree that a reproduced copy of this pre-employment consent and release form shall have the same force and effect as the original. I have carefully read the foregoing and fully understand its contents. I acknowledge that my signing of this consent and release form is a voluntary act on my part and that I have not been coerced into signing this document by anyone.

Check here to acknowledge/agree. *

I agree