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Application for Employment

We are an equal opportunity employer, dedicated to a policy of non-discrimination in employment on any basis including, race, color, age, sex, religion, handicap, or national origin.

Applicant Information
Are you 18 years of age or older? YesNo
Are you eligible to work in the United States? YesNo
Have you ever worked for this company? YesNo
Have you ever been convicted of a felony? YesNo
Education
Did you graduate? YesNo
Did you graduate? YesNo
Did you graduate? YesNo
References
Please list three professional references.
Previous Employment
May we contact your previous supervisor for a reference? YesNo
May we contact your previous supervisor for a reference? YesNo
May we contact your previous supervisor for a reference? YesNo
Military Service
Disclaimer and Signature
I certify that my answers are true and complete to the best of my knowledge.
Applicant Acknowledgement of Terms and Conditions of Application and/or Employment
It is very important that you read this section carefully, and that you fully understand it before you sign it. This section affects your legal rights. If you have questions, please ask a Valsource HR representative before you sign this application.
In Exchange for VALSOURCE INTERNATIONAL LLC’S consideration of this employment application:
  1. I understand that nothing in the application, or in any prior or subsequent written or oral statement, creates a contract of employment or any rights in the nature of a contract except for the Employment-At-Will and the Dispute Resolution Agreement.
  2. I promise that all information I have supplied in this application and any other form, oral or written, is true and accurate, and I agree that any misstated, misleading, incomplete, or false information is grounds for rejection and destruction of this application form, refusal to hire, withdrawal of an offer of employment, or immediate discharge without recourse, whenever and however discovered. I make this promise because I understand that you will rely in part, on my statements to you in making your decision whether to hire me.
  3. I understand and agree that ValSource International, LLC, any agent acting on their behalf, as well as any other person responding to a reference request pursuant to this application, can and will seek and/or disclose any and all information about me which said corporation, agent, or person may have. I specifically authorize said disclosure and agree to hold all such corporations, agents, or persons harmless for same. That is, I will not file a lawsuit, claim, or charge against them for such disclosure. Nor will I threaten same or otherwise seek any kind of compensation for such disclosure.
  4. I understand and agree with the fact that ValSource International, LLC maintains a drug-free workplace, that maintenance of same is essential to the safety of the workplace and employees, and that I may be required to undergo a pre-employment or post-employment examination, consistent with applicable law, including, but not limited to, drug and/or alcohol screening and testing, genetic screening, or paper and pencil test, designed to ascertain my suitability for employment and/or the jobs for which I am being considered. I also understand and agree that I will be subject to such testing during the course of my employment, and I specifically agree not to oppose in any fashion such pre-hire or post-hire testing. I understand that, subject to applicable law, ValSource International, LLC shall be the sole judge of acceptability of any test results. I also acknowledge that I have been advised the ValSource International, LLC is an Equal Opportunity Employer, and ValSource International, LLC does not discriminate against persons who are physically or mentally handicapped, and that ValSource International, LLC administers its employment policies in a non-discriminatory manner.
  5. I agree to look solely to the Compensation Insurance coverage provided by ValSource International, LLC and its Successors in the event of an injury to me during the course and scope of my employment. I will not seek any compensation benefits from any customer of ValSource International, LLC. I agree that any recovery which I might receive as the result of an injury received during the course and scope of my employment will be limited to the extent of ValSource International, LLC insurance coverage at the time of my injury. I agree to abide by the terms and conditions of all rules and regulations including ValSource International, LLC’s vehicle driving and seat belt policies and including without limitation, the requirement that any accident, or any injury, no matter how minor, be immediately reported to supervision.
  6. I authorize ValSource International, LLC to request and obtain all records regarding any industrial accident / injury or occupational disease involving myself and SUBSCRIBER. This is to include doctor’s reports, follow-up reports, nurse’s notes, medical bills, test results, etc. A facsimile or photocopy of this authorization shall be considered as effective and valid as the original. This release shall remain in effect until specifically rescinded by me.
  7. I, the undersigned, do hereby authorize ValSource International, LLC to examine any and all criminal records and arrests on file in the counties in the State of Texas or any other state. In doing so, I understand that I am waiving my right of confidentiality concerning my criminal history.
  8. I hereby authorize and give full permission to have ValSource International, LLC and/or their medical company physician send a specimen of my urine and/or blood to a laboratory for screening test using S.A.M.H.S.A. standards for the presence of illegal drugs, alcohol, or prescription medication taken without a prescription. I will hold all parties concerned harmless, meaning I will not sue nor hold responsible for any alleged harm to be or interfering with my obtaining a job or continuing employment due to not submitting to the tests or as a result of report of test. This includes, but not limited to, possible clerical or laboratory error. This policy and authorization has been explained to me in a language I understand and I was told if I have any questions about the test they will be answered. I understand this is a legal binding document which is binding because ValSource International, LLC is sending me for the examinations and paying for it.
  9. I understand and agree that, if hired, my employment will be at will, and that I or ValSource International, LLC can terminate this employment relationship at any time, with or without notice, for any reason, good or bad, without recourse by either of us. In the event of my separation, I agree to have the balance of all outstanding deductions to be withheld from my final paycheck. If my final paycheck is not sufficient to cover the balance due, I will pay the remaining amounts within thirty days of my last check date or other terms mutually agreed upon between me and ValSource International, LLC. I also understand that, if I am hired, ValSource International, LLC has an “introductory period” during which I am expected to determine as quickly as possible whether I wish to continue working for ValSource International, LLC, just as ValSource International, LLC will determine as quickly as possible whether it wants me to continue working for ValSource International, LLC. Nothing about this introductory period or its completion changes the fact that, if hired, my employment will be at will. I also understand that no one at ValSource International, LLC, or any ValSource International, LLC client, has authority to alter any of the terms and conditions of this application or ValSource International, LLC’s employment policies, except ValSource International, LLC’s Owner, and then only in writing signed by the Owner. This statement excludes the Employment-At-Will Policy and the Dispute Resolution Policy. The paragraph means exactly what it says.
  10. I specifically authorize ValSource International, LLC to investigate my background, including any and all references, available criminal, driving and other judicial records, and my credit record (where applicable to the position for which I am applying, and consistent with applicable law). I understand that ValSource International, LLC will notify me if and when a credit record investigation will be performed, and the sources used to obtain such information. I authorize ValSource International, LLC to use all legal means at its disposal to assess my suitability for employment. I make this authorization in return for ValSource International, LLC’s consideration of me for employment, and I specifically release and hold ValSource International, LLC harmless for any and all liabilities arising out of their investigation of my application for employment. I understand that ValSource International, LLC will require a drug screen test whenever an on-th-job accident or injury is reported in accordance with ValSource International, LLC’s HR policy, and this authorization and consent. My refusal to submit to drug testing will be grounds for termination of my employment, or withdrawal of offer of employment.
  11. I understand and agree that work schedules and requirements vary and can be unpredictable, and that, while ValSource International, LLC will make reasonable efforts to accommodate work schedules and employee availability, I may be required to work overtime, weekends, different shifts, or other arrangements. I consent to these requirements as necessary and legitimate conditions of employment.
  12. I understand if I am not hired within 30 days from the date of the application, I must complete a new application and employment packet. Also, if I terminate employment for longer than 30 days, I must complete a new Employment Packet. I have read and understand everything on the application.
  13. The Employee Handbook is provided to me for information and immediate reference. Not only will I be issued my own personal handbook, there will be a copy at my worksite employer’s location. I will read the handbook carefully and completely. Policies included except for the Employment-At-Will Policy and the Dispute Resolution Agreement are subject to unilateral change I by the Company from time to time. I acknowledge receipt of the Employee Handbook by signing below. I also certify that I have had, or will have, an opportunity to read and become familiar with the terms of the Employee Handbook before beginning work for ValSource International, LLC. I agree to abide by the terms and conditions of ValSource International, LLC, as pertains to policies as summarized in the handbook. I understand and agree that ValSource International, LLC reserves the right to change the terms and conditions of policies except for the Employment-At-Will Policy and the Dispute Resolution Agreement and my employment without notice to me, and that in all cases, the prevailing version of an employment policy shall govern if in conflict with the employee handbook.
  14. agree that a facsimile copy of my signature is acceptable as original documentation for the facilitation of employee maintenance by ValSource International, LLC including but not limited to this application.

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