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    Personal Information (this section is required)

    First Name *:

    Middle Name:

    Last Name *:

    Social Security *:

    D.O.B. *:

    Street Address *:

    Apt / Unit #:

    State *:

    City *:

    ZIP *:

    Phone *:

    E-mail Address *:

    Current/Previous Employment

    Company *:

    Phone *:

    Job Title *:

    Supervisor *:

    From *:

    To *:

    Emergency Contact (this section is required)

    Full Name *:

    Phone # *:

    Relationship *:
    SpousePartnerParentsSiblingGrandparentsAunt/UncleOther

    Other:

    By clicking below, you agree to the authorization to release records and our private policy noted below. Please read through completely before signing. *

    AUTHORIZATION TO RELEASE RECORDS

    I hereby authorize the Company to make a thorough investigation of my background prior to any potential contract work. I understand and agree that, the information supplied was submitted by me and all information is true and accurate, to the best of my knowledge. I understand that false or misleading information given will be consideed as cause for possible and/or immediate contract termination. Further, I understand that the information supplies by me regarding: Previous and Current Contracts, Education, Consumer Credit Reporting, Criminal Background History, Motor Vehicle Record(s), Social Security Verification, Residence History, References, Social & News Media and all Public Record(s) investigations may be utilized as part of the processing procedures. I release from liability all person, companies, and corporations supplying this information and indemnify the company against any liability that might result from making such inquires. A copy of this form is as valid as the original.

    Privacy Policy

    Last updated May 04, 2023

    The Company (“we” or “us” or “our”) respects the privacy of our users (“user” or “you”). This Privacy Policy explains how we collect, use, disclose, and safeguard your information when you fill out this application, including any other media form, media channel, mobile website, or mobile application related or connected thereto (collectively, the “application”). Please read this privacy policy carefully. If you do not agree with the terms of this privacy policy, please do not continue with this application.

    We reserve the right to make changes to this Privacy Policy at any time and for any reason. We will alert you about any changes by updating the “Last Updated” date of this Privacy Policy. Any changes or modifications will be effective immediately upon posting the updated Privacy Policy on the application, and you waive the right to receive specific notice of each such change or modification.

    You are encouraged to periodically review this Privacy Policy to stay informed of updates. You will be deemed to have been made aware of, will be subject to, and will be deemed to have accepted the changes in any revised Privacy Policy by your continued use of the application after the date such revised Privacy Policy is posted.

    We may collect information about you in a variety of ways. The information we may collect on the data form includes, personally identifiable information, such as your name, address, email address, and telephone number.

    Use of Your Information

    Having accurate information about you permits us to conduct a thorough background to verify information you have provided.

    Disclosure of Your Information

    You have authorized to share information we have collected about you in certain situations. Your information may be disclosed as follows:

    By Law or to Protect Rights

    If we believe the release of information about you is necessary to respond to legal process, to investigate or remedy potential violations of our policies, or to protect the rights, property, and safety of others, we may share your information as permitted or required by any applicable law, rule, or regulation. This includes exchanging information with other entities for fraud protection and credit risk reduction.

    Third-Party Service Providers

    We may share your information with third parties that perform services for us or on our behalf, including drug testing, background verification, social media searches and motor vehicle verification.

    Security of Your Information

    We use administrative, technical, and physical security measures to help protect your personal information. While we have taken reasonable steps to secure the personal information you provide to us, please be aware that despite our efforts, no security measures are perfect or impenetrable, and no method of data transmission can be guaranteed against any interception or other type of misuse. Any information disclosed online is vulnerable to interception and misuse by unauthorized parties. Therefore, we cannot guarantee complete security if you provide personal information.

    Policy for Children

    We do not knowingly solicit information from or market to children under the age of 13. If you become aware of any data we have collected from children under age 13, please contact us using the contact information provided below.

    Contact Us

    If you have questions or comments about this Privacy Policy, please contact us at apply@grgnetwork.com.

    Disclaimer and Signature

    I certify that my answers are true and complete to the best of my knowledge. I understand that false or misleading information may result in my release. I acknowledge that my signatures throughout this document are done electronically on the date noted.

    Date *:

    Front of SS Card *

    Back of SS Card *

    Front of Drivers License *

    Back of Drivers License *

    Front of Permanent Resident Alien Card or Employment Authorization (if any)

    Back of Permanent Resident Alien Card or Employment Authorization (if any)

    Passport or Birth Certificate (if any)

    Headshot Photo (ID/Badge) *

    DIRECT DEPOSIT AUTHORIZATION

    By clicking the submit button, I freely give my authorization. Please read completely before signing.

    I hereby authorize Payroll to directly deposit my pay in the bank account(s) listed above in the amounts or percentages specified. If two accounts are designated, deposits are to be made in whole percentages of pay to total 100%. This authorization is to remain in force until the Company has received written authorization from me of its termination or change. Also, I hereby grant Payroll the right to correct any such electronic funds transfer resulting an erroneous overpayment by debiting my account to the extent of such overpayment.

    First Name and Middle Initial *

    Last Name *

    Date *

    Financial Institution (Bank Name) *

    Bank Phone Number (optional)

    Account Number *

    Routing Number *

    Signature *


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