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TO WHOM IT MAY CONCERN:
THE FOLLOWING INDIVIDUAL HAS APPLIED FOR A POSITION WITH OUR COMPANY.
DUE TO THE NATURE OF OUR BUSINESS, WE REQUEST A CRIMINAL RECORD CHECK TO BE RETURNED TO ADDRESS: ARMORED KNIGHTS INC.
2330 PAUL STREET
OMAHA NE, 68102
IN ACCORDANCE WITH THE PROVISIONS OF SECTION 604 AND SECTION 607 OF THE FAIR CREDIT REPORTING ACR, PUBLIC LAW No. 91-508, I HEREBY CERTIFY THAT THE INFORMATION REQUESTED WILL BE USED FOR “PERMISSIBLE PURPOSES” AS DEFFIND IN THE ACT, AND THAT THE INFORMATION RECEIVED WILL BE USED FOR NO OTHER PURPOSE. I FURTHER CERTIFY THAT IF THE APPLICANT IS DENIED EMPLOYMENT BASED ON THE INFORMATION RECEIVED, I WILL IDENTIFY THE SOURCE OF THE REPORT IN ACCORDANCE WITH SECTION 615 ( a ) OF THE FAIR CREDIT REPORTING ACT.
NAME OF APPLICANT_____________________________________________________________________
ADDRESS_______________________________________________________________________
PREVIOUS ADDRESS_______________________________________________________________________
RACE________________SEX___________________DATE OF BIRTH_______________________________
DRIVERS LICENSE #___________________________________STATE OF ISSUE_____________________
SINCERELY YOURS,
ARMORED KNIGHTS INC._____________________________________DATE________________________
REPLY
NO CONVICTION RECORD FOUND
CONVICTION RECORD AS FOLLOWS:
APPLICATION/EMPLOYEE ACKNOWLEDGEMENT AGREEMENT
EMPLOYMENT AT ARMORED KNIGHTS INC. IS A TERMINATION AT WILLS RELATIONSHIP.
YOU SHOULD UNDERSTAND THAT THE NATURE OF ARMORED KNIGHTS BUSINESS REQUIERS A THOROUGH HIRING PROCESS. YOU MUST PASS ALL SUCH QUALIFICATION STANDARDS AND TESTS TO BE CONSIDERED FOR EMPLOYMENT. IN SOME CASES, IT TAKES LONGER TO GET RESULTS THAN ARMORED KNIGHTS PREFERS. CONSEQUENTLY, ARMORED KNIGHTS MAY OFFER EMPLOYMENT AND HIRE AN INDIVIDUAL BEFORE ALL THE HIRING PROCEDURES HAVE BEEN COMPLETED.
YOU MUST BE AWARE AND YOU HEREBY ACKNOWLEDGE THAT IF YOU ARE HIRED BEFORE THE RESULTS OF ALL HIRING PROCEDURES ARE KNOWN, AND THE RESULTS OF THESE PROCEDURES ARE NOT SATISFACTORY TO ARMORED KNIGHTS WHEN THEY ARE COMPLETED, THAT THE OFFER FOR EMPLOYMENT IS REVOKED AND YOU WILL BE TERMINATED.
YOU MUST SIGN AND DATE THIS ACKNOWLEDGEMENT. YOUR SIGNATURE ATTESTS TO THE FACT THAT YOU HAVE READ AND UNDERSTAND THE MEANING OF THIS ACKNOWLEDGMENT.
SIGANATURE_______________________________PRINT NAME__________________________________
DATE______________________________
AKI WITNESS_______________________________
SUPPLEMENT TO APPLICATION
CONDITION OF EMPLOYMENT
STATEMENT OF DRIVER INSURABILITY AND DRUG FREE WORK PLACE
APPLICANT (PRINT NAME) ____________________________________________________
FILL IN THE BLANK:
I ______________________________________UNDERSTAND THAT AS A CONDITION OF MY EMPLOYMENT, AND THROUGHOUT THE TERM OF MY EMPLOYMENT WITH ARMORED KNIGHTS INC. THAT MY CONTINUED EMPLOYMENT DEPENDS ON MY ABILITY TO MAINTAIN MY STATUS AS A LEGAL, INSURABLE DRIVER. I ALSO UNDERSTAND THAT IF I BECOME UNINSURABLE, DUE TO TRAFFIC VIOLATIONS RECEIVED ON OR OFF THE JOB DURING MY TERM OF EMPLOYMENT, REGARDLESS OF FAULT; I AM SUBJECT TO IMMEDIATE TERMINATION. SCREENING TEST FOR ALCOHOL AND ILLEGAL DRUG USE MAY BE REQUIRED BEFORE HIRING AND DURING YOUR EMPLOYMENT.
APPLICANT SIGNATURE____________________________________
DATE______________________________________________________
AKI WITNESS______________________________________________
EMPLOYEE’S CHOICE OR CHANGE OF DOCTOR FORM
NOTICE TO EMPLOYER: GIVE THIS FORM TO THE INJURED WORKER AS SOON AS POSSIBLE AFTER EACH INJURY.
RIGHTS OF THE EMPLOYEE:
UNDER THE NEBRASKA WORKERS’ COMPENSATION LAWS, YOU MAY HAVE THE RIGHT TO CHOOSE A DOCTOR TO TREAT YOU FOR YOUR WORK RELATED INJURY. YOU MAY CHOOSE A DOCTOR WHO HAS TREATED YOU OR AN IMMEDIATE FAMILY MEMBER BEFORE THIS INJURY HAPPENED. IMMEDIATE FAMILY MEMBERS YOUR SPOUSE, CHILDREN, PARENTS, STEPCHILDREN AND STEPPARENTS. THE DOCTOR YOU CHOOSE MUST HAVE RECOREDS TO SHOW THAT PAST TREATMENT WAS PROVIDED. YOUR EMPLOYER MAY ASK THE PERSON WHO WAS TREATED TO GIVE PERMISSION SO THE DOCTOR CAN VERIFY PAST TREATMENT.
IF YOU WANT TO CHOOSE YOUR DOCTOR, YOU MUST TELL YOUR EMPLOYER THE NAME OF THE DOCTOR YOU CHOOSE. DO THIS AS SOON AS POSSIBLE AFTER YOUR EMPLOYER GIVES YOU THIS NOTICE AND BEFORE GETTING ANY TREATMENT UNLESS IT IS EMERGENCY MEDICAL TREATMENT. ONCE YOU TELL YOUR EMPLOYER THE NAME OF THE DOCTOR, YOU MAY NOT CHANGE YOUR CHOICE UNLESS YOU’RE EMPLOYER AGREES OR THE NEBRASKA WORKERS’ COMPENSATION COURT ORDERS A CHANGE.
IF YOU DO NOT CHOOSE YOUR DOCTOR, YOUR EMPLOYER HAS THE RIGHT TO CHOOSE THE DOCTOR TO TREAT YOU. THE EMPLOYER MAY ALSO CHOOSE THE DOCTOR TO TREAT YOU IF YOU OR YOUR FAMILY MEMBER DOES NOT GIVE PERMISSION SO YOUR EMPLOYER CAN VERIFY PAST TREATMENT BY THE DOCTOR YOU CHOSE.
YOU MAY CHOOSE A DOCTOR IF YOUR CLAIM IS DENIED. YOU MAY ALSO CHOOSE THE DOCTOR TO DO MAJOR SURGERY OR FOR AN AMPUTATION.
YOU MAY USE PART B BELOW TO TELL YOUR EMPLOYER THE NAME OF THE DOCTOR YOU CHOOSE.
B: CHOICE OF DOCTOR
I CHOOSE THE FOLLOWING DOCTOR TO TREAT ME FOR THIS WORKRELATED INJURY. I CERTIFY THAT THIS DOCTOR HAS TREATED ME OR AN IMMEDIATE
FAMILY MEMBER BEFORE THE WORK RELATED INJURY.
I DO NOT HAVE OR I DO NOT WISH TO CHOOSE A DOCTOR WHO HAS TREATED ME OR AN IMMEDIATE FAMILY MEMBER.
____________________________________ __________________________________
DOCTOR’S NAME SIGNATURE OF EMPLOYEE
____________________________________ __________________________________
DOCTOR’S ADDRESS DATE
______________________________________________________________________________________________________
C: USE TO CHANGE THE CHOICE MADE IN PART B, ABOVE
I WISH TO CHANGE MY CHOICE OF DOCTOR OR I WISH TO CHOOSE A DOCTOR TO TREAT ME FOR MY
WORK RELATED INJURY. I CERTIFY THE DOCTOR NAMED BELOW HAS TREATED ME OR AN
IMMEDIATE FAMILY MEMBER BEFORE THIS WORK RELATED INJURY. I UNDERSTAND THAT I
CANNOT MAKE THIS CHANGE UNLESS MY EMPLOYER AGREES OR UNLESS THE NEBRASKA
WORKERS’ COMPENSATION COURT ORDERS A CHANGE.
____________________________________ _______________________________________
DOCTOR’S NAME SIGNATURE OF EMPLOYEE DATE
90 Day Probationary Period
As a new hire, Armored Knights does have a 90 day probationary period. This period will be used to determine if you are able to work in this environment. Dependability, Promptness, Trustworthy, Neatness, Cooperative, Courteous, Responsible and Physically Fit are the qualities that you will be evaluated on after 90 days. After this time we will make the decision as to whether you will be made a permanent employee of Armored Knights, Inc.
Termination of Employment
Any Employee who voluntarily terminates his/her own employment with Armored Knights, Inc. without a proper written Two (2) week notice, will receive their last paycheck at the current minimum wage rate.
APPLICANT SIGNATURE____________________________________
DATE______________________________________________________
AKI WITNESS______________________________________________
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