Full Name *

First

Middle

Last

Birth Date *

MM123456789101112DD12345678910111213141516171819202122232425262728293031YYYY2025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920

Current Address

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

--- Select country ---AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBolivia (Plurinational State of)Bonaire, Saint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos (Keeling) IslandsColombiaComorosCongoCongo (Democratic Republic of the)Cook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Kingdom of)EthiopiaFalkland Islands (Malvinas)Faroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHondurasHong KongHungaryIcelandIndiaIndonesiaIran (Islamic Republic of)IraqIreland (Republic of)Isle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea (Democratic People's Republic of)Korea (Republic of)KosovoKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesia (Federated States of)Moldova (Republic of)MonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth Macedonia (Republic of)Northern Mariana IslandsNorwayOmanPakistanPalauPalestine (State of)PanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint Martin (French part)Saint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint Maarten (Dutch part)SlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyrian Arab RepublicTaiwan, Republic of ChinaTajikistanTanzania (United Republic of)ThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUgandaUkraineUnited Arab EmiratesUnited Kingdom of Great Britain and Northern IrelandUnited States Minor Outlying IslandsUnited States of AmericaUruguayUzbekistanVanuatuVatican City StateVenezuela (Bolivarian Republic of)VietnamVirgin Islands (British)Virgin Islands (U.S.)Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland IslandsCountry

Email Address *

Email

Confirm Email

Phone Number *

Position AppliedPlease SelectServerBartenderBanquet Set UpCookPrep CookCashierConcession Stand WorkerGrill CookHouse KeeperLaundry AttendantDishwashserWarehouse RunnerBusser

How did you hear about usPlease SelectLinkedInEventSocial MediaReferral

Referral

Available Start Date

Upload Your Resume/Certifications

Click or drag files to this area to upload. You can upload up to 5 files.

For Previous Employers

Select Employers

• 1
• 2
• 3

1 Employer

---

Name

Address

Position Held

Supervisor

Start Date

MM123456789101112DD12345678910111213141516171819202122232425262728293031YYYY2025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920

End Date

MM123456789101112DD12345678910111213141516171819202122232425262728293031YYYY2025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920

Phone

Email of supervisor

2 Employer

---

Name

Address

Position Held

Supervisor

Start Date

MM123456789101112DD12345678910111213141516171819202122232425262728293031YYYY2025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920

End Date

MM123456789101112DD12345678910111213141516171819202122232425262728293031YYYY2025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920

Phone

Email of supervisor

3 Employer

---

Name

Address

Position Held

Supervisor

Start Date

MM123456789101112DD12345678910111213141516171819202122232425262728293031YYYY2025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920

End Date

MM123456789101112DD12345678910111213141516171819202122232425262728293031YYYY2025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920

Phone

Email of supervisor

Next

In order to place you effectively on assignment matching your skills and qualifications, we need to know a little more about you. Please complete each section and check all the boxes below that apply to you and enter information as indicated. If you have any questions or need an accommodation for this questionnaire, please ask.

What days are you available to work?

• Monday
• Tuesday
• Wednesday
• Thursday
• Friday
• Saturday
• Sunday
• NA

Please select the Front of House positions and skills in which you have verifiable work experience:

• Banquet Serving
• Busser
• Room Service
• Cashier
• Waiter/Waitress
• Banquet Captain
• Bartender
• Cocktail Serving
• Concessions
• Bar Back
• Fine Dining
• NA

Please select the Back of House / Culinary positions and skills in which you have verifiable work experience:

• Dishwasher
• General Kitchen
• Pantry
• Banquet Setup
• Prep Cook
• Pastry
• Cook -> What type?
• Chef ->What Type?
• NA

Cook -> What type?

Chef -> What type?

Please select the other positions and/or skills in which you have verifiable work experience:

• Admin / Clerical
• Food & Beverage
• Housekeeping
• Hospital Services
• Inventory
• NA

Do you have reliable transportation for all shift hours you are available to work?

• Yes
• No
• NA

Please select the attire and tools you currently, own or have access to (clothing may not have holes, stains, or frays)

---

Shirts

• Men"s Black Oxford Dress Shirt
• Men"s White Oxford Dress Shirt
• White Wing Tip Tuxedo Shirt
• Denim Shirt - Long Sleeve
• Hawaiian Shirt
• White Polo Shirt
• Chef"s Coat
• White T-Shirt

Pants

• Black Dress Pants
• Black Tuxedo Pants
• Khaki/Tan Slacks
• Khaki/Tan Shorts
• Navy Blue Dress Slacks
• Navy Blue Dress Shorts
• Chef Pants

Accessories

• Black Straight Tie
• Black Bow Tie
• Black Cummerbund
• Black Tuxedo Vest
• Black Tuxedo Jacket

Shoes

• Black Polishable Non-slip Shoes
• Black Tennis Non-slip Shoes
• White Tennis Non-slip Shoes

Tools

• Chef"s Knives
• Bar Kit
• Wine Key
• Lighter

Miscellaneous

• AZ DPS Level 1 Fingerprint Clearance Card
• T.I.P.S. Certification
• Other

Other

Have you ever applied with or worked at any of the following companies? If yes, please enter the location and dates of employment below:

• Aramark / Aventure
• Sodexo
• Levy
• Marriott

If yes, when?

If yes, when?

If yes, when?

If yes, when?

Have you worked for any other staffing agencies at any time?

• Yes
• No

If you answered "Yes" in question 8, please list the staffing agencies you have worked or are working for:

Printed Name *

Signature *

Clear Signature

Date *

PreviousNext

In order to effectively place you on an assignment matching your skills and qualifications, we need to know a little more about you and your experience relative to serving, bartending, and culinary skills. Please complete each section to the best of your ability. Please write in your name and date on page 1 below. Complete the questions by selecting the appropriate check boxes or filling in the information below for the sections that apply to you and the position(s) you seek. Be sure to sign and date the Acknowledgment section on the last page. If you have any questions or need an accommodation for this questionnaire please ask.

SECTION I: BANQUET SERVER QUESTIONNAIRE

---

Food Safety

What is the correct way to wash your hands?

• Rinse hands with hot, running water and dry them with a paper towel
• Only use a quarter-sized amount of hand sanitizer
• Scrub hands for 10-15 seconds with soap and warm water, rinse for 5-10 seconds, then dry them with a paper towel
• Scrub hands in a sanitizer bucket and dry with a cotton towel

Why are all food service workers required to understand and apply food safety knowledge?

• To reduce workplace accidents such as cuts and burns
• To reduce the amount of food thrown away due to spoilage
• To prevent the spread of illness through food
• To reduce the number of complaints from customers

When you wear gloves you must:

• Put new gloves on every hour
• Continue to wash your hands
• Wash the gloves daily to remove food
• Clean your nails daily

What is the difference between washing and sanitizing?

• There is no difference
• Washing makes things look clean and sanitizing makes them smell good
• Washing removes contamination and sanitizing whitens
• Washing removes contamination and sanitizing destroys microorganisms

If a customer tells you they have a food allergy, what should you do?

• Refer
• Review
• Remember
• Respond
• All of the above

What should you, as a food service worker, do if a person has an allergic reaction in your food establishment?

• Tell your manager and dial 911
• Call the Health Department
• Take a break
• Make new food for the guest

It is an acceptable practice to place a knife in a sink full of water:

• True
• False

When making a sanitizing solution, you MUST use test strips:

• True
• False

Eating in the kitchen is acceptable as long as nobody sees you eat:

• True
• False

Keeping your work area clean is the responsibility of the dishwasher:

• True
• False

PreviousContinue

SECTION II: BANQUET SERVER QUESTIONNAIRE

---

Are you interested in a position as a bartender?

• Yes
• No

If a guest orders alcohol in this state, when do you ask for an ID? Is it when he/she appears to be :

• 18 years of age or younger
• 21 years of age or younger
• 25 years of age or younger
• 30 years of age or younger
• 60 years of age or younger
• Any age

What are the signs of intoxication?

• Slurred speech
• Loss of inhibitions
• Poor coordination
• All of the above

Which of the following can be used to quickly lower Blood Alcohol Concentration (BAC) levels?

• Soda / Pop
• Coffee
• Milk
• All of the above
• None of the above

When should a bartender taste the alcohol at an event to ensure good quality?

• Only if the alcohol looks like it is going bad
• Bartenders should taste all alcohol served at events
• Bartenders should only taste wines
• Bartenders should never taste any liquor at events

Name three items contained in a bar kit:

How many ounces does one shot consist of?

• 1
• 2
• 3
• 4

Rum is used in the making of which of the following drinks?

• Cosmopolitan
• Daiquiri
• Manhattan
• Irish Car Bomb

A drink ordered as "neat" generally refers to :

• Single, unmixed liquor served without being chilled and without any water or ice
• Shaken, not stirred
• Served with cocktail parasols
• Single, unmixed liquor served over ice

What makes a martini "dry"?

• Little or no ice
• Little or no vermouth
• Olive juice
• Absinthe

A draft beer means that it was poured from:

• A bottle
• A tap
• A tumbler
• A shaker

A microbrew is a beer:

• Served in very small glasses
• That is flavored
• Served in very small bottles
• Brewed in a small commercial brewery

Generally, which wine best compliments seafood?

• Pinot Noir
• Chardonnay
• Cabernet
• Chianti

When pouring wine, how much wine, as a standard, should be poured?

• 3 ounces
• 6 ounces
• 8 ounces
• 9 ounces

Generally, which wine is served chilled?

• Merlot
• Chardonnay
• Pinot Noir
• Chianti

Generally, "well" liquor is the house's cheapest alcohol:

• True
• False

Imported beer is always dark beer:

• True
• False

"Brut" is the sweetness designation of a dry sparkling wine:

• True
• False

It is acceptable to scoop ice with a glass:

• True
• False

A red wine glass is larger than a white wine glass:

• True
• False

All vodka is made from potatoes:

• True
• False

Chianti is a white wine:

• True
• False

Pinot Noir is a red wine:

• True
• False

Scotch is a type of whiskey:

• True
• False

Merlot is a white wine:

• True
• False

Name the following drinks based on their ingredients:

• Vodka + Triple Sec + Cranberry Juice + Lime Juice
• Malibu Rum + Pineapple + Cranberry Juice
• Vodka + Tomato Juice + Spices
• Vodka + Orange Juice
• Gin + Dry Vermouth
• Tequila + Sweet & Sour + Triple Sec + Lime Juice

Name

Name

Name

Name

Name

Name

PreviousContinue

SECTION III: BANQUET SERVER QUESTIONNAIRE

---

Are you interested in a position as a banquet server?

• Yes
• No

From which side of the guest do you serve food?

• Right
• Left

From which side of the guest do you serve beverages?

• Right
• Left

From which side of the guest do you clear items?

• Right
• Left

When placing an entrée, the main item (protein: fish, meat, fowl) should face the guest at:

• 9 o"clock
• 12 o’clock
• 6 o"clock
• 4 o"clock

What is a Sterno?

• Disinfectant
• An ashtray
• A heating device
• A scrubbing pad

If instructed to clear the entrée plates “at 90 percent," how many guests out of 10 should be finished with their meals before you start bushing the entrée plates?

• 3
• 1
• 8
• 9

When a guest is seated at a table, assuming that the center of the table is 12 o'clock, at what position is their coffee cup handle placed?

• 2 o"clock
• 3 o"clock
• 4 o"clock
• 5 o"clock

What is pre-meal or pre-shift?

• Salad
• Meeting
• Type of Service
• Setting Tables

What is a chafing dish?

• Bussing tray
• Big Soup Pot
• Rectangular food tray
• Equipment for serving hot food

What is a “slush/slop” bucket?

• A large ashtray
• A gravy boat
• Container for excess liquids
• Ice bucket for chilling champagne

What is a B&B?

• A bussing station
• Bed & Breakfast
• Bread and Butter Plates
• Buffet and Basket Service

What does “B.E.O.” stand for?

• Banquet Event On-Call
• Banquet Event Order
• Basic Evaluation Order
• Beginning Event on Time

What is a tray jack?

• A wine opener
• A stand to place trays on
• A large oval tray
• Push cart with wheels

What is a Queen Mary?

• Princess Cruise Line
• A big boat
• A vase
• A large cart with racks

What three things should a server always have in his/her pocket?

• Wine key, cigarette, notepad
• Towel, pen, notepad
• Wine key, pen, matches or lighter
• Napkin, matches, pen

If you are a front server and a guest asks you for a vegetarian menu, would you:

• Tell them you do not have vegetarian meals
• Go to the kitchen and ask the chef
• Tell your back server
• Remove meat from the plate

Forks are set to the left of the entrée plate:

• True
• False

The salad fork is set closest to the entrée plate:

• True
• False

The sharpened side of the knife faces away from the entrée plate:

• True
• False

The water is set above the knives:

• True
• False

PreviousContinue

Dishwasher Essentials

Are you interested in a position as a dishwasher?

• Yes
• No

Which of the following kills germs?

• Washing
• Sanitizing
• Rinsing
• Air Drying
• None of the above

Which is the correct way to wash dishes, utensils and equipment?

• Pre-scrape, wash, rinse, sanitize, then air dry
• Pre-scrape, wash, rinse, and dry completely with a towel
• Pre-scrape, wash, rinse, than air dry

It is acceptable to store chemicals on the shelf above food and clean utensils:

• True
• False

As a dishwasher you don't have to worry about following proper hand washing procedures:

• True
• False

It is acceptable for dishwashers to eat out of food pans that come back from the kitchen:

• True
• False

Prep / Pantry Essentials

Are you interested in Prep or Pantry positions?

• Yes
• No

You are asked to get 2 cups of water. How many ounces does that equal (hint: 1 cup = 8 ounces)?

• 8 ounces
• 16 ounces
• 32 ounces
• 48 ounces

Ready to eat food is :

• Food that was just delivered from an approved source
• Food that needs to be reheated to 165°F before serving
• Moist, protein-rich goods that support the rapid growth of bacteria
• Food that will not be cooked or reheated before being served to the customer

You do not need to wear a cutting glove if you have experience properly using knives:

• True
• False

Mozzarella cheese is white in color:

• True
• False

"Julienne" means cutting food into thin strips:

• True
• False

PreviousContinue

Cook Essentials

Are you Interested in a cook positions?

• Yes
• No

Which of the following are considered food allergens?

• Milk
• Eggs
• Peanuts
• Wheat
• Fish
• Shellfish
• Tree nuts
• Soybeans
• All of the above
• None of the above

Which of the following must be cooked to a minimum of 165°F

• Poultry
• Ground meats
• Beef and pork
• Seafood

The ’Danger Zone” refers to :

• Holding temperatures above 135°F
• The temperature range between 41°F and 135°F
• An awesome 1980"s song
• A high-risk work area

Potentially hazardous foods that support the rapid growth of bacteria are:

• Dry, protein-rich foods
• Dry, fat-rich foods
• Moist, fat-rich foods
• Moist, protein-rich foods

Cross-contamination is :

• When germs spread from one place to another
• Nothing to be concerned about
• When you wipe blood in a cross motion
• Protein-rich foods that support the rapid growth of bacteria

Cold, potentially hazardous food must be held at a minimum temperature of:

• 41°F
• 55°F
• 65°F
• 70°F

"Brunoise" means cutting food into tiny cubes:

• True
• False

Spinach is commonly associated with Caesar salad:

• True
• False

Define the terms:

• Binding
• Butterfly
• Clarify
• Fillet
• Emulsion
• Parboiling
• Poached
• Trussed

Definitions:

a. Stirring ingredients into a hot liquid to thicken it.

b. A mixture of liquids that are normally unbendable.

c. To tie the wings and legs of a fowl before cooking.

d. Cutting the bones out of a piece of meat or fish

e. Partially cooking food in boiling water.

f. Cooking In a simmering liquid.

g. Purifying a liquid; often butter.

h. To cut open a food item as a means to cook It faster.

Blinding

Butterfly

Clarify

Fillet

Emulsion

Parboiling

Poached

Trussed

Congratulations

You"re finished with the questionnaire. Please sign and date below. Thank you for taking the time to comptete this questionnaire so that we could learn a litge bit more about you and your experiences.

Acknowledgment

I certify that all the Information I have provided in all Sections is true, accurate and complete. I also understand that completing this questionnaire is not a guarantee of placement on assignment or at any particular client company. I understand that if I am on-boarded, nothing in this document changes the at wll nature of this relationship . I am free to resign at will at any time. with or without cause. Similarly, Rogue Events, LLC may terminate the relationship at any time with or without cause. Finally, I understand that if I have questions about the contents of this document that I should contact my Rogue Events, LLC Representative or Manager right away.

Print Name *

Signature *

Clear Signature

Date *

PreviousNext

Independent Contractor Service Agreement

This Independent Contractor Agreement (Agreement) is entered into between Rogue Events, LLC (Company), and the independent contractor (Contractor), in consideration of the mutual promises made herein, as follows:

Term of Agreement

This Agreement will become effective on the date signed below and will continue to stay in effect until terminated by either party with written notice.

Services to be Rendered by Contractor

Contractor agrees to provide services in accordance with their skills and abilities.

Method of Performing Services

Contractor will determine the method, details, and means of performing the specific services, at the Contractor"s own expense. The Company may not control, direct, or otherwise supervise Contractors assistants or employees in the performance of those services.

Compensation

In consideration for the services to be performed by Contractor, Company agrees to pay Contractor the sum of the agreed upon hourly pay rate for the total number of hours worked within a reasonable time.

Tools and Instruments

Contractor will supply all tools, equipment, and supplies required to perform the services under this Agreement.

Workers Compensation

Contractor understands that they are performing services as a self employed individual and agrees to indemnify Company for any and all claims arising out of any injury, disability, or death of any of Contractor"s employees or agents.

Obligations of Company

Company agrees to meet the terms of all reasonable requests of Contractor necessary to the performance of Contractor"s duties under this Agreement.

Termination of Agreement

Notwithstanding any other provisions of this Agreement, either party hereto may terminate this Agreement at any time by giving 30 days written notice to the other party.

Partial Invalidity

If any provision of this Agreement is held by a court of competent jurisdiction to be invalid, void, or unenforceable, the remaining provisions shall nevertheless continue in full force without being impaired or invalidated in any way.

Governing Law

This Agreement shall be governed by and construed in accordance with the laws of the State of Arizona.

Owner *

Date *

By signing below, I understand and acknowledge: that I am an independent contractor and that I am responsible for keeping track of my earnings; that I am not an employee, I am a non-employee providing services on an at-will basis; that I am responsible for paying my own taxes, and that no taxes are being withheld from my earnings, nor am I eligible for any employee benefits. I further understand that I will receive a 1099 form from the company and not a W2.

Name/Company *

Date *

---

Consent to Background and Reference Check

Applicant Name: *

Present Address: *

I, hereby authorize Rogue Events (the "Company") of 3104 E Camelback Rd #2132, Phoenix, Arizona 85016, and/or its agents to make investigation of my background, references, character, past employment, consumer reports, education, and criminal history record information which may be in any state or local files, including those maintained by both public and private organizations, and all public records, for the purpose of confirming the information contained on my application and/or obtaining other information which may be material to my qualifications for employment. A telephone facsimile (fax) or xerographic copy of this consent shall be considered as valid as the original consent.

I hereby consent to the Company"s verification of all the information I have provided on my application form. I also agree to execute as a condition of employment or a condition of continued employment any additional written authorization necessary for the Company to obtain access to and copies of records pertaining to this information. I also hereby authorize the Company"s access to any medical histories or records pertaining to me (and any other individuals who due to my employment may be covered by any Company medical or other insurance program). With regard to the foregoing disclosures, I hereby agree to release any person, company, or other entity from any and all causes of action that otherwise might arise from supplying the Company with information it may request pursuant to this release. I understand that any false answers or statements, or misrepresentations by omission, made by me on this application or any related document, will be sufficient for rejection of my application or for my immediate discharge should such falsifications or misrepresentations be discovered after I am employed.

By : *

Clear Signature

Date *

---

Staff Drug Testing Consent

I, Applicant Name, of Applicant Address, hereby agree, upon a request made under the drug testing policy of Rogue Events, LLC of 3143 E Camelback Rd #2132, Phoenix, AZ 85016, to submit to a drug test and to furnish a sample of my urine, breath, and/or blood for analysis. I understand and agree that if I at any time refuse to submit to a drug test under Company policy, or if I otherwise fail to cooperate with the testing procedures, I will be subject to immediate termination. I further authorize and give full permission to have the Company and/or its Company physician send the specimen or specimens so collected to a laboratory for a screening test for the presence of any prohibited substances under the policy, and for the laboratory or other testing facility to release any and all documentation relating to such test to the Company and/or to any governmental entity involved in a legal proceeding or investigation connected with the test. Finally, I authorize the Company to disclose any documentation relating to such test to any governmental entity involved in a legal proceeding or investigation connected with the test. I will hold harmless the Company, Company physician, and any testing laboratory the Company might use, meaning that I will not sue or hold responsible such parties for any alleged harm to me that might result from such testing, including loss of employment or any other kind of adverse job action that might arise as a result of the drug test, even if a Company or laboratory representative makes an error in the administration or analysis of the test or the reporting of the results. I will further hold harmless the Company, its Company physician, and any testing laboratory the Company might use for any alleged harm to me that might result from the release or use of information or documentation relating to the drug test, as long as the release or use of the information is within the scope of this policy and the procedures as explained in the paragraph above. This policy and authorization have been explained to me in a language I understand, and I have been told that if I have any questions about the test or the policy, they will be answered. I understand that the Company will require a drug screen test under this policy whenever I am involved in an on-the-job accident or injury under circumstances that suggest possible involvement or influence of drugs in the accident or injury event.

By *

Clear Signature

Date *

Layout

Previous

Submit