Individualized Assessment Form

The following background review information is used in combination with the pre-employment due diligence process. Indicating criminal background histroy will not be automatic grounds for cancellation of employment offer. Failure to disclose background and/or falsification of information, however, may be terms for cancellation of the assignment.

Have you ever been convicted of a felony, convicted of a misdemeanor, received deferred adjudication, been convicted of an offense involving dishonesty or moral turpitude, or convicted in a military court martial? (A conviction will not automatically bar you from employment.)

All Applicants:  Exclude any records expunged, annulled, sealed, or discharged under first-offender law.

Massachusetts Applicants:  An applicant for employment with a sealed record on file with the commissioner of probation may answer "no record" with respect to an inquiry herein relative to prior arrests, criminal court appearances, or convictions.  In addition, any applicant for employment may answer "no record" with respect to any inquiry relative to prior arrests, court appearances, and adjudications in all cases of delinquency or as a child in need of services which did not result in a complaint transferred to the superior court for criminal prosecution.  The applicant may exclude a first conviction for any of the following misdemeanors:  drunkenness, simple assault, speeding, minor traffic violations, affray or disturbance of the peace.  The applicant may exclude any convictions of misdemeanors which are more than five years old.

California Applicants:  You may exclude convictions for possession of small amounts of marijuana if such convictions are more than two years old.

Hawaii Applicants:  Do NOT answer the criminal record questions.

During the past seven years, have you ever been convicted of, plead guilty to, or received probation, deferred adjudication, or any other type of alternative method of supervision or correction for a misdemeanor, having a penalty of imprisonment or a fine of more than $500, or a felony? (Answering Yes is not an automatic bar to employment but will be considered in relation to specific job requirements.)

Have you been convicted of a crime? (Exclude minor traffic cases; Include DUIs.)

If you answered  NO in the above section, you may advance to the end/bottom of this background acknowledgement form.

ONLY If you answered  YES to any of the above questions, then you must respond to the individualized assessment below.  Indication of conviction may not bar you from employment insomuch that it is not job related.  Any and all offenses, however, should be included in the areas provided below.  

Certificate of Candidate

(To Be Completed By All Candidates)

General: I have submitted the attached form to Frontline Source Group, Inc. (hereinafter referred to as "FSG") and Frontline Source Group Holdings, LLC (hereinafter referred to as "FSGH") for the purpose of obtaining assistance in securing full-time, part-time, temporary, and/or contract employment.  I acknowledge that the use of this form, and my filling it out, does not indicate that any positions are open, nor does it obligate FSG or FSGH to further process my application.  I hereby affirm that the information provided on this application (and accompanying resume, if any) is true and complete to be the best of my knowledge.  I also agree that falsified information or significant omissions may disqualify me from further consideration for employment and may be considered justification for dismissal if discovered at a later date. This form serves as my acknowledgement of my partnership with FSG and FSGH and my further right to be represented by the firm.

Direct Hire / Temporary / Contract Employment: If employed as a temporary or contract employee, I understand that I will be an employee FSGH of FSG.  If employed, I further understand that my employment is not guaranteed for any specific time and may be terminated at any time for any reason.  I further understand that a contract will exist between FSG or FSGH and each client to whom I may be assigned which will require the client to pay a fee to FSG or FSGH in the event I accept direct employment with the client.  I agree to notify my FSG or FSGH recruiter immediately should I be offered direct employment by a client (or by a referral of the client to any subsidiary or affiliated company), either for a full-time, part-time, temporary (including assignments through another agency), or consulting positions within twelve months after the last day of any assignment period or interview.   If I violate this and accept employment with, and without the acknowledgement of FSG or FSGH, I may become liable for the fees due to FSG or FSGH.  I understand that the Client of FSG or FSGH will pay FSG or FSGH a fee and should that Client not pay FSG or FSGH per the terms of the agreement that I may be asked to not return to the assignment.  If I violate this request and continue to work for the Client I understand that I will become liable for the fees due to FSG or FSGH and possibly a party to collections or legal action.

FSG and FSGH are not professional accounting firms.  I will not render an opinion on behalf of FSG or FSGH on financial information (i.e. tax returns, financial statements, etc.).  I will not sign the name of FSG or FSGH or my name to tax returns or financial information for any client.  I will not handle cash, checks or any other items of value without the prior written consent of my FSG or FSGH recruiter.  Under no circumstances will I transport cash, negotiable or other valuables.

References: I understand and authorize FSG or FSGH to obtain employment history verification for employment purposes that may include information as to my character, general reputation, personal characteristics, and mode of living, work experience and performance, along with reasons for termination of past employment.  I authorize all persons listed above (and on the accompanying resume, if any) to give FSG or FSGH any and all information concerning my previous employment and education and any pertinent information they may have, personal or otherwise, and release all parties, such persons and FSG or FSGH from liability for any damage that may result from furnishing same to FSG or FSGH.

 

By completing and submitting this statement, I agree to its terms and conditions and acknowledge that I have read the above information and that my signature thereto may be implied.