Employment pre-application for Grinnell

Certification of Information I understand that I am applying for employment with Temp Associates, doing business locally through Temp Associates, hereinafter jointly referred to as ”Temp Associates.” By signing below, I declare that the information I have provides in the application process is complete and true to the best of my knowledge. I understand and agree that any false information, will result in dismissal at any time during my employment.

Application and Equal Opportunity Temp Associates is an Equal Employment Opportunity company. All qualified applicants will receive consideration without regard to gender, marital status, race, color, age, creed, religion, national origin, veteran status or disability. I understand that this form is for use in evaluating my qualifications for employment; it is not an offer or a promise of employment. A background investigation, interview, reference check, various tests and a policy review may be required before any final determination of my suitability for employment is made.

Drug Use and Test I understand that Temp Associates prohibits the use of illegal drugs. I am willing to provide a urine, blood, hair or saliva specimen for drug and/or alcohol testing prior to and/or during my employment as a condition of assignment to certain job positions, or if there is any reason whatsoever to suspect drug or alcohol use. I understand that company policy requires a drug test and alcohol test whenever there is an on-job accident or injury. The drugs that will be tested for are Amphetamines, Barbiturates, Benzodiazepines, Cocaine, Methadone, Methaqualone, Propoxyphene, Phencyclidine, Opiates including morphine and codeine, and Cannabinoids and any hemp product. We may also perform tests to detect adulterants or substances to mask the detection of drugs. To be qualified for employment with Temp Associates we must receive a ”negative” report on the drug screen. If that qualification is not met, the prospective employee that has been extended and offer will be withdrawn. I hereby release Temp Associates, its clients and any clinic, individual or test product manufacturer that may administer or provide a drug or alcohol test from any and all claims arising out of the results of such a test, and from any action taken on the basis of those results.

I am voluntarily signing below to acknowledge that I have read and fully understand the certification and acknowledgements above. I have the opportunity to ask questions before signing, and all explanation has been in a language I understand. Release of Information I further authorize any individual, company, firm, corporation, or public agency (including the Social Security Administration and law enforcement agencies) to divulge any and all information, verbal or written, pertaining to me to Temp Associates or its agents. I further authorize the complete release of any records or data pertaining to me which the individual, company, firm, corporation, or public agency may have, to include information or data received from other sources. I hereby release Temp Associates, the Social Security administration, and it's agents, officials, representatives, or assigned agencies, including officers, employees, or related personnel both individually and collectively, from any and all liability for damages of whatever kind, which may at any time, result to me, my heirs, family, or associates because of the compliance with this authorization and request to release. You may contact me as indicated below.

Electronic Signature (Required) I acknowledge this is an electronic signature
Full Name
(Please indicate FULL legal name - ie: John L Smith Sr)

Date of Birth   ,


Contact Number OR E-Mail Address Please enter a contact number or e-mail address


Positions you are interested in (If Applicable) 1 )  

Current Address (Required) Street Address:  Apt/Unit:
City & State:     
Zip Code:         

How many years have you lived at this address:


Application Options for Grinnell