Please note our online application uses an SSL certificate for security, encrypts the data and is HIPPA compliant.
I authorize Felder Services independent investigation of my driving record (MVR), background, police and criminal history record information pertaining to me which may be in any state or local criminal justice agency in the United States, Workmen's Compensation and all public records for the purpose of conforming the information contained on my application, resume, or other supporting information which may be relevant to my qualifications for employment.
I release Felder Services and/or its agents in any person or entity that provides information pursuant to this authorization from any and all liabilities, claims or lawsuits in regards to the information obtained from any and all of the above reference sources used. I further understand if Felder Services and its agents would adhear to applicable state and federal statute concerning the securing of information, handling, and release of information obtained in the pre employment investigation.
The following is my true and complete legal name. All information on this document is true and correct to the best of my knowledge.
All other names ever used (include maiden name and names from previous marriages) Applicants are requested to put the approach approximate years of each name used to ensure that the correct name is used at each previous location. Otherwise, the verification process may be delayed because the employer/education cannot be verified.
Address History for Past 7 years
CertificationI certify that the information is true and complete. I understand that any false statement I have made herein or my failure to disclose requested information may disqualify me for consideration for employment, or if employed, may result in my termination. I further authorize Felder Services LLC or its agents to perform an investigation of local, state, and federal records relating to any criminal convictions I may have. In addition, Felder Services LLC has my permission to obtain all necessary information from the references I hove listed, or any other sources, concerning my prior employment, personal history, or criminal history and I release all parties from any possible damage resulting from disclosing such information with or without prior written notice to me.
I understand and acknowledge that I may be required to undergo a post-offer pre-employment physical exam and a post-offer pre-employment drug screening analysis for substance abuse. I understand that these may, to the extent permitted by law, result in the revocation of any offer of employment.
I certify that this application does not constitute an employment contract of any kind. I further acknowledge that, if I am offered a position with Felder Services LLC, my employment may be terminated at any time, with or without notice or cause, except as otherwise provided by law.