Job Service Application

JOB SERVICE APPLICATION

WHEREAS, Service Provider Name: operates a job placement and workforce services program offering recruitment, assessment, and placement services; and

WHEREAS, Applicant Name: seeks enrollment in those services and agrees to the terms and acknowledgements set forth in this Application; and

WHEREAS, the parties agree that submission of this Application constitutes an offer to enroll and authorizes the Service Provider to proceed with verifications and service provision as described below effective on Effective Date: .

Applicant Information

Position and Availability

Available Start Date:    Available Hours per Week:

Employment Type Sought: Full-time Part-time Temporary/Contract

Scope of Work / Services

The Service Provider will provide recruitment, candidate evaluation, skills assessment, interview coordination, and placement services as reasonably necessary to assist the Applicant in obtaining employment. Applicant requests the following specific services and authorizes implementation as described below:

Payment Terms

Service Fee Amount: . Fee is due as indicated in the schedule below. Applicant agrees fees are non-refundable except as expressly provided in the Service Provider's placement fee policy.

Late Payment Fee: . Applicant acknowledges responsibility for collection costs and interest for delinquent balances.

Term and Termination

Enrollment Term Start Date: . Term End Date (if applicable): .

Either party may terminate participation upon written notice to the other party. Notice Period (days): . Termination does not relieve Applicant of payment obligations incurred prior to termination.

Confidentiality

The parties agree that Applicant records, employment history, resume content, assessment results, and employer communications are confidential. Service Provider will not disclose confidential information except as necessary to perform services, to comply with law, or with Applicant's prior written consent. Applicant expressly authorizes disclosure of relevant information to prospective employers and third-party verifiers as required for placement.

Background, Verification and Authorization

Applicant acknowledges that Service Provider will verify employment history, education, professional credentials, and may obtain consumer reports, criminal history checks, and other verifications as permitted by law. By checking the box below Applicant gives consent for such verifications.

I authorize verification of the information contained herein and consent to background checks and reference checks as described above.

Have you ever been convicted of a felony?   Yes No

Employment History (Most Recent)

Education and Credentials

References

Governing Law and Entire Agreement

This Application, together with any separate fee agreement executed between Applicant and Service Provider, constitutes the entire agreement between the parties with respect to the subject matter herein and supersedes prior representations, negotiations, or agreements. This Application shall be governed by and construed in accordance with the laws of the state indicated by Service Provider Name above, without regard to conflict of law rules.

Acknowledgment and Certification

By signing below, Applicant certifies that all information provided in this Application is true and complete to the best of Applicant's knowledge. Applicant understands that intentional misrepresentation or omission of information may be grounds for denial of services or termination of any placement or agreement. Applicant authorizes Service Provider to contact employers, references, and educational institutions to verify information supplied.

Applicant Initials:    I acknowledge receipt of and agreement to these terms: Yes

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