BUSINESS REFERENCES
List 3 individuals, other than employment, know to you for at least 3 years.

ADDITIONAL INFORMATION

Please include any other information you think would be helpful to us in considering you for employment, such as additional work experience, articles/books published, activities, honors received, etc. (You may omit all information that wouild indicate age, sex, sexual orientation, race, religion, color, national origin, or disability.)

During the past ten years have you ever been convicted of, pled guilty to, or received probation, deferred adjudication, or any other type of alternative method of supervision or correction for a misdemeanor, having a penalty of imprisonment or a fine of more than $500, or a felony? (Answering Yes is not an automatic bar to employment, but will be considered in relation to specific job requirements.)

Have you been convicted of a crime (exclude minor traffic cases: include DUIs)?

Are criminal charges now pending against you?

(Please read the following statement carefully.)

I hereby affirm that the information provided on this application (and accompanying resume, if any) is true and complete to the best of my knowledge. I also agree that falsified information or significant omissions may disqualify me from further consideration for employment and may be considered justification for dismissal if discovered at a later date.

I authorize all persons listed above (and on the accompanying resume, if any) to give PPT, Inc. any and all information concerning my previous employment and education and any pertinent information they may have, personal or otherwise, and release all parties, and such persons from liability for any damage that may result from furnishing same to PPT, Inc.

I understand that PPT, Inc. may obtain a consumer and/or investigative report for employment purposes that may include information regarding prior employment, work experience and performance, reasons for employment termination, and information as to character, general reputation, personal characteristics, or mode of living. The report may also contain a records check of driving, criminal, credit, education, degrees, professional licenses and/or certification records depending on the position. By signing this application, I authorize the procurement of a consumer and/or investigative consumer report by PPT, Inc. as part of the pre-employment background investigation and if hired, at any time during my employment.

I understand and agree that I may be required to take a drug and alcohol screening test. I hereby give my voluntary consent for a blood and/or urine sample to be collected from me and submitted for testing. I also consent to the release of the test result to PPT, Inc. for its use. I understand that any positive drug or alcohol result may preclude my employment.

PPT Certification and Release
By signing the “Electronic Signature” above, you are now ready to submit your final PPT Employment Application. To submit this application, please enter the key(s) you see in the box below, then click on the ‘Submit” button.