Application for Employment

This is a pre-employment questionnaire. MBD Company is an Equal Opportunity Employer.

You must click the Submit Application button at the bottom of this form. You will receive a message on the screen that says "Employment application submitted successfully" once you have successfully submitted your application.

Date of application: Oct 24 2017, 5:39 am EDT

Personal Information

(If different from permanent address)

Employment Desired

Education/Military Service


Provide the name of three persons not related you, whom you have known at least one year:

Reference #1

Reference #2

Reference #3

Former Employers

List below last three employers, last one first:

Employer #1

Employer #2

Employer #3

Emergency Contact

Please list the name and phone number of nearest relative, neighbor, or person to contact in the event of an emergency:

Certification and Authorization

“I certify that all the information submitted by me on this application is true and complete, and I understand that if any false information, omissions, or misrepresentations are discovered, my application may be rejected and, if I am employed, my employment may be terminated at any time."

"In consideration of my employment, I agree to conform to MBD Company rules and policies, and I agree that my employment and compensation can be terminated, with or without cause, and with or without notice, at any time, at either my option or MBD Company option. I also understand and agree that the terms and conditions of my employment may be changed, with or without cause, and with or without notice, at any time by the company."

"I authorize schools, references, and prior employers to provide my record, reason for leaving employment, and all other information they may have concerning me to MBD Company and I release all parties providing information from any and all liability or claims for damages whatsoever that may result from this information’s release and use."

By entering your full name below, you acknowledge that you have read the above Certification and Authorization and agree to its terms:

Consents and Acknowledgements

In order to complete our hiring requirements please complete the consent and acknowledgement sections below.

Drug test consent

I hereby consent to submit to urinalysis and/or other tests as shall be determined by MBD Company, LLC in the selection process of applicants for employment, for the purpose of determining the drug content thereof.

I agree that the specified clinic may collect these specimens for these tests and may test them or forward them to a testing laboratory designated by the company for analysis.

I further agree to and hereby authorize the release of the results of said tests to the company and the local union if applicable.

I understand that it is the current illegal use of drugs and/or abuse of alcohol that prohibits me from being employed at this company.

I understand that certain medications may cause a positive test result. Thus, I HAVE READ THE INFORMATION BELOW REGARDING THE DRUG TEST.

I further agree to hold harmless the company and its agents (including the above named physician or clinic) from any liability arising in whole or part out of the collection of specimens, testing, and use of the information from said testing in connection with the company’s consideration of my employment application.

I further agree that a reproduced copy of this pre-employment consent and release form shall have the same force and effect as the original.

I have carefully read the foregoing and fully understand its contents. I acknowledge that my signing of this consent and release form is voluntary act on my part and that I have not been coerced into signing this document by anyone.

  • Amphetamines
  • Marijuana/THC
  • Cocaine
  • Barbituates
  • Propoxyphene
  • Methaqualone
  • Opiates
  • Phencyclidine/PCP
  • Benzodiazapines
  • Methadone
  • Oxycodone
  • Cammabinoid

Certain over-the-counter and prescription medications may affect the results of a drug screening test. The following is a partial list, which is provided to help you recall the types of prescription or over-the-counter drugs you may have taken in the past 30 days. You may be asked by the Medical Review Officer to provide proof of a legal prescription in the case of use of prescription medication.

  • Heart Medication
  • Asthma Medicine
  • Allergy or Sinus Medicine
  • Laxatives or Diarrhea Medicine
  • Nausea Medicine
  • Stomach or Intestinal Medicine
  • Diet Pills
  • Depression Medicine or Mood Elevator
  • Tranquilizers, “Nerve” Medicine
  • Sleeping Pills
  • Muscle Relaxers
  • Seizure Medication
  • Pain Medication
  • Cold Medicine

Employee handbook acknowledgement

The employee handbook describes important information about MBD Company, LLC, and I understand that I should consult the Vice President of Human Resources regarding any questions not answered in the handbook. I have entered into my employment relationship with MBD Company, LLC voluntarily and acknowledge that there is no specified length of employment. Accordingly, either I or MBD Company, LLC can terminate the relationship at will, with or without cause, at any time, so long as there is no violation of applicable federal or state law.

Since the information, policies, and benefits described here are necessarily subject to change, I acknowledge that revisions to the handbook may occur, except MBD Company, LLC’s policy of employment-at-will. All such changes will be communicated through official notices, and I understand that revised information may supersede, modify, or eliminate existing policies. Only the chief executive officer of MBD Company, LLC has the ability to adopt any revisions to the policies in this handbook.

Furthermore, I acknowledge that this handbook is neither a contract of employment nor a legal document. I have received the handbook, and I understand that it is my responsibility to read and comply with the policies contained in this handbook and any revisions made to it.

Drug-free workplace acknowledgement

Paycheck policy acknowledgement

For all employees not working in the vicinity of our headquarters in Knoxville, TN, we strongly recommend the direct deposit method for employee pay. Direct depostis are made each Friday, and my be made to bank accounts or debit cards.

For employees that choose a printed paycheck, we cannot guarantee that the payments will arrive on Friday due to delays in the postal service or other delivery services which are beyond our control. It is the responsibility of the employee to ensure their mailing address is current. The present address on this application will be where your check will be sent until the office is notified otherwise.

In the event you are hired you will be given the option to sign up for direct deposit. At that time any questions may be directed to the Knoxville office.

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