Application

Equal Employment Opportunity Statement:

Employment decisions will be based on the principles of equal opportunity. All personnel actions (recruiting, hiring, training, promotion, compensation, etc.) are administered without regard to any characteristic protected by state, federal or local law, assuming said characteristic does not interfere with the performance of essential job functions. Reasonable accommodations will be made for disabilities and religious beliefs. Please inform us of any necessary accommodations to the application process.

Are you legally permitted to work in the United States? *

Yes No

Note: Proof of eligibility will be required within three working days of employment.

Are you 18 years of age or older? *

Yes No

Have you been convicted of a felony within the last 7 years? *

Yes No

If "Yes" Explain: *

Note: Such conviction does not necessarily prevent you from employment. H&H X-Ray Services, Inc. is an equal opportunity employer.

Are you willing to take drug tests at the Company's request? *

Yes No

Have you ever successfully completed a 40 Hr Radiation Safety School? *

Yes No

If "Yes" Specify Date and School Attended *

Note: Class is required for all employees working with radiation.

Do you have a current Industrial Radiographer State Card? *

Yes No

Do you have a High School Diploma or GED? *

Yes No

Physical Record:

List any Physical Defects

Vision: *

Hearing: *

Other: *

Were you ever Injured? Explain: *

Military Service:

Have you ever served in the U.S. military? *

Yes No

NOTE: If you answered "No" to the above question, please skip the rest of this section.

What was the length of your military service? (years-months) *

What was your rank at time of discharge *

What type of training and work experience did you receive while in the military *

APPLICANT'S STATEMENT

I certify that the information provided in this application is true, to the best of my knowledge.

I understand that providing false or misleading information at any time during the application and interview process may lead to refusal to hire or discharge from the Company. If I become employed by the Company, I agree to follow all rules and regulations of the Company as they develop and change.

I allow the Company to conduct investigations on me, my background and my performance, and am aware that such investigations will become a part of my employment record. With this, I authorize the Company to speak with my acquaintances, personal and professional, to gather information about me.

I authorize all former employers and references to provide any information about me to the Company, and release them of liabilities and damages of all kinds for providing this information. I authorize the Company to verify the accuracy of the information within this application. I also authorize the release of my educational transcripts to the Company for education verification purposes.

I release H&H X-Ray Services, Inc. from liability for collecting information about me and using it to make employment decisions.

If I become employed by the Company, I understand that the employment relationship will be “at will,” and that the “at will” status may not change at any time unless specifically approved, in writing, by the CEO of the Company.

I agree that if I become indebted to the Company, I will be responsible for repaying the total owed upon termination from the Company. If I do not repay the sum prior to my final paycheck being received, the money owed will be deducted from my pay.

This application for employment is valid for the next 90 days. I understand that if I wish to be considered for employment after this period of time, I must apply again.

H & H X-Ray Services, Inc.Application for Employment

APPLICANT'S STATEMENT

H & H X-Ray Services, Inc.
Application for Employment