Career Application

LICENSE INFORMATION

Section 383.21 FMCSR states “No person who operates a commercial motor vehicle shall at any time have more than one driver’s license”. I certify that I do not have more than one motor vehicle license, the information for which is listed below.

PLEASE READ CAREFULLY BEFORE YOU INITIAL AND SIGN THIS APPLICATION. APPLICATION MUST BE COMPLETED IN FULL EVEN IF ATTACHING A RESUME.

I certify that the information provided on this application is truthful and accurate. I understand that proving false or misleading information will be the basis for rejection of my application, or if employment commences, immediate termination.

I authorize AGRX to contact former employers and educational organizations regarding my employment and education. I authorize my former employers and educational organizations to communicate information fully and freely regarding my previous employment and education.

If an employment relationship is created, I understand that unless I am offered a specific written contract of employment signed on behalf of the organization by its Administration, the employment relationship will be "at will. In other words, the relationship at any time and without cause. With appropriate notice, I have the full and complete discretion to end the employment relationship when I chose and for reasons of my choice. Similarly, my employer will have the right. Moreover, no agent, representative, or employee of AGRX, except in a specific written contract of employment signed on behalf of the organization by its Administration, has the power to alter or vary the voluntary nature of the employment relationship.

As a condition of employment, I may be required to pass a drug screening test and undergo a background check. Failure to pass the drug screening or background check will void any offer or potential offer of employment. AG RX follows all FCRA, state and local laws, Ban the Box and the 2012 EEOC guidance regarding the use of criminal records in the employment process.

I HAVE CAREFULLY READ THE ABOVE CERTIFICATION AND I UNDERSTAND AND AGREE TO ITS TERMS.

I authorize you to make sure investigations and inquiries to my personal, employment, or medical history and other related matters as may be necessary in arriving at an employment decision. (Generally, inquiries regarding medical history will be made only if and after a conditional offer of employment has been extended.) I hereby release employers, schools, health care providers and other persons from all liability in responding to inquiries and releasing information in connection with my application.

In the event of employment, I understand that false or misleading information given in my application or interview(s) may result in discharge. I understand, also, that I am required to abide by all rules and regulations of the Company.

I understand that information I provide regarding current and/or previous employers may be used, and those employer(s) will be contacted, for the purpose of investigating my safety performance history as required by 49 CFR 391.23(d) and (e). I understand that I have the right to:

• Review information provided by current/previous employers;
• Have errors in the information corrected by previous employers and for those previous employers to re-send the corrected information to the prospective employer;
• Have a rebuttal statement attached to the alleged erroneous information, if the previous employer(s) and I cannot agree on the accuracy of the information.”

This certifies that I completed this application, and that all entries on it and information in it are true and complete to the best of my knowledge.

Note: A motor carrier may require an applicant to provide information in addition to the information required by the Federal Motor Carrier Safety Regulations.