Abstract Internet Application Form

Submitted By leifeerman1
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Pages: 16

This application has been created as an Adobe form (to make sure you have the latest version of adobe, click here.) in order to allow you, the applicant, to complete the form electronically. You will complete the form by entering information into text boxes, indicating answers by clicking on check boxes or choosing from a drop-down menu of choices.To select multiple answers in a drop down menu, hold down the ctrl key. Use the Tab or arrow keys to navigate from field to field. Where a signature is required, you will sign the form electronically by typing your name into the text field provided. Text fields will resize to accommodate your answers. This may change the page layout of the form but you need not be concerned by this. Be certain to save your changes to your computer before returning the form via email or FAX. Since this form may take some time to complete, we recommend you save your work periodically so as not to lose any answers should an error occur. We also suggest you print a copy of this packet for your records. Please don’t hesitate to contact us for assistance in completing this form at: (303) 850-9080. Thank you, The Team at MEDDirect


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6834 S University Blvd. Centennial, CO 80122 Tel: 303-850-9080 Fax: 303-850-9799 info@meddirectrecruiting.com

MEDDirect Recruiting & Staffing
Have you ever been convicted of a felony or misdemeanor, including guilty and nolo contendere pleas (including any type of DUI, DWAI, etc.)? This includes deferred sentences & pending charges. An answer of “yes” to this question will not automatically disqualify you from consideration for employment. However, you may wish to contact MEDDirect to discuss your answer before continuing with the remainder of the application process. Yes No Offense: When:

MEDDirect recognizes the importance of employees who are honest, trustworthy, qualified, reliable and nonviolent. For purposes of furthering these concerns and interests, before hiring an individual, MEDDirect reserves the right to investigate the individual’s background and credit reports as defined in the Fair Credit Reporting Act (FCRA). I, , hereby authorize MEDDirect and/or it’s agents to make an independent investigation of my background, police and criminal records, references, character, past employment, education and the child support registry, including those maintained by both public and private retail and security organizations, law enforcement agencies and all public records for the sole purpose of confirming the information contained on my employment application forms and/or obtaining other information which may be material to my qualifications for employment. I understand that inquiries on this form which address day and month of birth are used for identification verification purposes only and as such, are asked in good faith for legitimate, nondiscriminatory reasons. I release MEDDirect and/or its agents and any person or entity which provides information pursuant to this authorization, from any and all liabilities, claims, or lawsuits in regard to the information obtained from any and all of the above referenced sources used. I further agree that the giving of any false or misleading information either on my application or this form will be grounds for termination of my employment. Consistent with legal requirements, MEDDirect reserves the right to exclude any applicant from consideration for employment where the applicant refuses to sign the Background Investigation Consent form as requested. I also allow MEDDirect to disclose any information obtained to potential employers. The following is my true and complete legal name and all information is true and correct to the best of my knowledge. I agree that a copy or facsimile of this consent shall be as valid as the original. PLEASE PRINT ALL INFORMATION ON THIS FORM For security reasons, you can fill out