Forman Ford Glass and Glazing Contractors EMPLOYMENT APPLICATION

Transcription

1 Frman Frd Glass and Glazing Cntractrs EPLOYENT APPLICATION FOR ANAGERS USE ONLY Equal access t prgrams, services, and emplyment is available t all persns. Applicants requiring reasnable accmmdatin t the applicatin and/r interview prcess shuld ntify a representative f the Human Resurces Department. We are an equal pprtunity emplyer and d nt discriminate in any aspect f emplyment n the basis f race, clr, religin, gender, age, natinal rigin, disability, citizenship status, veteran status, r any ther legally prtected status in accrdance with the requirements f federal, state, and lcal law. Hiring Cmpany: Date: Wage: Psitin: Previusly Held By: Lcatin: Full Time Part Time Date: NAE LAST FIRST IDDLE ADDRESS NO. & STREET CITY STATE ZIP CODE AREA CODE/TELEPHONE NO. PERSONAL PREVIOUS ADDRESS: NO. & STREET CITY STATE ZIP CODE ARE YOU AT LEAST 8 YEARS OF AGE? WHO REFERRED YOU TO THIS COPANY? ARE YOU WILLING TO WORK OVERTIE? YES NO YES NO EERGENCY NOTIFICATION (List name f persn t be ntified in case f emergency) Name (, First, iddle) Address (Street, City, State, Zip) Area Cde/Telephne N. PREFERENCES POSITION(S) APPLIED FOR Full Time Part Time AY WE CONTACT YOUR PRESENT EPLOYER BEFORE YOUR EPLOYENT ENDS? YES NO DATE AVAILABLE FOR WORK SALARY DESIRED SENIOR HIGH SCHOOL LOCATION Diplma GPA YES NO COLLEGE LOCATION Type f Degree ajr GPA Circle Year Cmpleted EDUCATION COLLEGE LOCATION Type f Degree ajr GPA OTHER LOCATION Type f Degree - Certificate GPA N. f s. EXTRA-CURRICULAR ACTIVITIES AND OFFICES HELD PROFESSIONAL AFFILIATIONS PROFESSIONAL CERTIFICATIONS OR DESIGNATIONS CAPABLE OF OPERATING: Frklift Calculatr snal Cmputer Pwer Tls ulti-line Phne System Other: GENERAL HAVE YOU SERVED IN THE ARED FORCES? ARE YOU A RESERVE OR GUARD EBER? YOUR RESERVE OR GUARD STATUS YES NO YES NO Active Standby

2 List belw all present and past emplyment, beginning with yur mst recent (Include address and area cde with phne numbers) Name and Address f Cmpany and Type f Business Frm T Describe the wrk yu did Reasn fr Name f Supervisr (Area Cde) Telephne 2 Name and Address f Cmpany and Type f Business Frm T Describe the wrk yu did Reasn fr Name f Supervisr (Area Cde) Telephne 3 Name and Address f Cmpany and Type f Business Frm T Describe the wrk yu did Reasn fr Name f Supervisr PREVIOUS EPLOYENT (Area Cde) Telephne 4 Name and Address f Cmpany and Type f Business Frm T Describe the wrk yu did Reasn fr Name f Supervisr (Area Cde) Telephne 5 Name and Address f Cmpany and Type f Business Frm T Describe the wrk yu did Reasn fr Name f Supervisr (Area Cde) Telephne 6 Name and Address f Cmpany and Type f Business Frm T Describe the wrk yu did Reasn fr Name f Supervisr (Area Cde) Telephne

3 GIVE THE NAES AND ADDRESSES OF THREE PERSONS NOT RELATIVES OR FORER EPLOYERS WHO AY BE CONTACTED NAE NAE NAE NUBER AND STREET ADDRESS NUBER AND STREET ADDRESS NUBER AND STREET ADDRESS REFERENCES CITY, STATE, ZIP CITY, STATE, ZIP CITY, STATE, ZIP TELEPHONE YEARS KNOWN TELEPHONE YEARS KNOWN TELEPHONE YEARS KNOWN OCCUPATION OCCUPATION OCCUPATION SUPERVISORY EXPERIENCE Have yu ever supervised peple? YES NO If yes, explain nature f supervisin: TRAINING AND EXPERIENCE OTHER TRAINING AND EXPERIENCE Describe any training, experience r qualificatins (nt previusly cvered) that might be f interest t the cmpany. Fr example: Wrd prcessing, freign languages yu can speak fluently, etc. TO BE COPLETED BY APPLICANTS FOR POSITIONS REQUIRING THE USE OF OTOR VEHICLES ONLY D yu have a valid driver s license fr this state? YES NO Expiratin Date Driver s License N. DRIVERS State Hw many mtr vehicle vilatins have yu received within the past 5 years? Have yu been cnvicted fr driving while intxicated within the past 5 years? YES NO Number f Cnvictins RECORDS HAVE YOU EVER BEEN CONVICTED OF OR PLEAD GUILTY TO ANY OFFENSE THAT INVOLVES EBEZZLEENT, FRAUD, DISHONESTY OR STEALING? Yu are nt bligated t disclse sealed r expunged recrds f cnvictin r arrest. A cnvictin will nt necessarily disqualify yu frm emplyment. It will be cnsidered nly as it may relate t the jb yu are seeking. IF YES, EXPLAIN: YES NO

4 APPLICANT S STATEENT By signing belw, I certify that the answers and infrmatin set ut abve are true, accurate and cmplete t the best f my knwledge. I acknwledge that if any answer r infrmatin is nt true, accurate r cmplete, I may nt be hired, r if hired, I may be discharged. I authrize the Cmpany t investigate all statements cntained in this applicatin fr emplyment and t investigate my character and qualificatins. I authrize my prir emplyers, references, and thers with infrmatin regarding my wrk r educatinal histry r my character, t prvide the Cmpany with all requested infrmatin and references, and t cperate fully with the investigatin f my character and qualificatins. I give permissin t all current r previus emplyers and/r managers t discuss my persnal and emplyment histry with the Cmpany, cnsent t the release f such infrmatin, and release them frm all liability and all claims based upn any statements r infrmatin they prvide. AGREEENT I understand that this applicatin is nt a cntract f emplyment. I als acknwledge that n ral representatins have been made, and that n ne within the Cmpany has the authrity t make ral cntracts f emplyment. If hired, my emplyment relatinship with the Cmpany is terminable at will, with r withut cause, by either myself r the Cmpany except as prvided by ntana law. I als understand that any ffer f emplyment may be cnditinal upn my passing a pst-ffer physical examinatin r my ability t perfrm the essential jb functins, with r withut accmmdatin, and drugalchl test administered by a health care prfessinal selected by Cmpany, t which I hereby cnsent. I understand and agree t all f the cnditins and statements set frth abve, and thrughut this applicatin. Date Signature f Applicant Printed Name

5 NOTIFICATION OF PROCUREENT OF CONSUER REPORT Thrugh this dcument, FORAN FORD GLASS AND GLAZING CONTRACTORS ( Cmpany ) is putting yu n ntice and disclsing t yu that Cmpany may btain a cnsumer reprt fr emplyment purpses as part f its pre-emplyment backgrund investigatin. In additin, such a cnsumer reprt may be btained at any time during yur emplyment. BACKGROUND CHECK AUTHORIZATION I, the undersigned cnsumer, d hereby authrize Cmpany, by and thrugh its independent cntractr, t prcure a cnsumer reprt n me. This abve-mentined reprt may include, but is nt limited t, emplyment and educatin verificatins; my persnal credit histry based n reprts frm any credit bureau; my driving histry, including any traffic citatins; a scial security number verificatin; present and frmer addresses; criminal and civil histry/recrds; any ther public recrd; and, any ther infrmatin bearing n my credit standing, credit capacity, and/r credit wrthiness. I further authrize any persn, business entity r gvernmental agency wh may have infrmatin relevant t the abve t disclse the same t Cmpany, including, but nt limited t, any curthuse, any public agency, any and all law enfrcement agencies and any and all credit bureaus, regardless f whether such persn, business entity r gvernmental agency cmpiled the infrmatin itself r received it frm ther surces. I understand that this authrizatin shall remain n file and shall serve as an nging authrizatin fr Cmpany t btain cnsumer reprts at any time during my emplyment, fr emplyment purpses. I hereby release Cmpany and any and all persns, business entities and gvernmental agencies, whether public r private, frm any and all liability, claims and/r demands, f whatever kind, t me, my heirs r thers making such claim r demand n my behalf, fr prcuring, selling, prviding, brkering and/r assisting with the cmpilatin r preparatin f the cnsumer reprt hereby authrized. PRINTED NAE: FIRST IDDLE LAST SIGNATURE: DATE: STREET NUBER/PO BOX STREET NAE COPLETE RESIDENCE ADDRESS: CITY STATE ZIP CODE COUNTY SOCIAL SECURITY NUBER: DAYTIE TELEPHONE NUBER: DRIVER S LICENSE NUBER: STATE OF ISSUANCE: DATE OF BIRTH*: * This infrmatin will be used nly fr prper identificatin purpses during the curse f ur backgrund search as well as in the event we find adverse infrmatin during the curse f ur backgrund search. We cmply with the Age Discriminatin in Emplyment Act. Therefre, this infrmatin will nt be used t discriminate n the basis f age.

6 Para-infrmacin en espanl, visite escribe a la FTC Cnsumer Respnse Center, Rm 30-A, 600 Pennsylvania Ave. N.W., Washingtn, D.C A SUARY OF YOUR RIGHTS UNDER THE FAIR CREDIT REPORTING ACT The federal Fair Credit Reprting Act (FCRA) prmtes the accuracy, fairness, and privacy f infrmatin in the files f cnsumer reprting agencies. There are many types f cnsumer reprting agencies, including credit bureaus and specialty agencies (such as agencies that sell infrmatin abut check writing histries, medical recrds, and rental histry recrds). Here is a summary f yur majr rights under the FCRA. Fr mre infrmatin, including infrmatin abut additinal rights, g t r write t: Cnsumer Respnse Center, Rm 30-A, Federal Trade Cmmissin, 600 Pennsylvania Ave. N.W., Washingtn, D.C Yu must be tld if infrmatin in yur file has been used against yu. Anyne wh uses a credit reprt r anther type f cnsumer reprt t deny yur applicatin fr credit, insurance, r emplyment--r t take anther adverse actin against yu--must tell yu, and must give yu the name, address, and phne number f the agency that prvided the infrmatin. Yu have the right t knw what is in yur file. Yu may request and btain all the infrmatin abut yu in the files f a cnsumer reprting agency (yur file disclsure ). Yu will be required t prvide prper identificatin, which may include yur Scial Security number. In many cases, the disclsure will be free. Yu are entitled t a free file disclsure if: a persn has taken adverse actin against yu because f infrmatin in yur credit reprt; yu are the victim f identity theft and place a fraud alert in yur file; yur file cntains inaccurate infrmatin as a result f fraud; yu are n public assistance; yu are unemplyed but expect t apply fr emplyment within 60 days. In additin, by September 2005 all cnsumers will be entitled t ne free disclsure every 2 mnths upn request frm each natinwide credit bureau and frm natinwide specialty cnsumer reprting agencies. See fr additinal infrmatin. Yu have the right t ask fr a credit scre. Credit scres are numerical summaries f yur credit-wrthiness based n infrmatin frm credit bureaus. Yu may request a credit scre frm cnsumer reprting agencies that create scres r distribute scres used in residential real prperty lans, but yu will have t pay fr it. In sme mrtgage transactins, yu will receive credit scre infrmatin fr free frm the mrtgage lender. Yu have the right t dispute incmplete r inaccurate infrmatin. If yu identify infrmatin in yur file that is incmplete r inaccurate, and reprt it t the cnsumer reprting agency, the agency must investigate unless yur dispute is frivlus. See fr an explanatin f dispute prcedures. Cnsumer reprting agencies must crrect r delete inaccurate, incmplete, r unverifiable infrmatin. Inaccurate, incmplete r unverifiable infrmatin must be remved r crrected, usually within 30 days. Hwever, a cnsumer reprting agency may cntinue t reprt infrmatin it has verified as accurate. Cnsumer reprting agencies may nt reprt utdated negative infrmatin. In mst cases, a cnsumer reprting agency may nt reprt negative infrmatin that is mre than seven years ld, r bankruptcies that are mre than ten years ld. Access t yur file is limited. A cnsumer reprting agency may prvide infrmatin abut yu nly t peple with a valid need--usually t cnsider an applicatin with a creditr, insurer, emplyer, landlrd, r ther business. The FCRA specifies thse with a valid need fr access. Yu must give yur cnsent fr reprts t be prvided t emplyers. A cnsumer reprting agency may nt give ut infrmatin abut yu t yur emplyer, r a ptential emplyer, withut yur written cnsent given t the emplyer. Written cnsent generally is nt required in the trucking industry. Fr mre infrmatin, g t Yu may limit prescreened ffers f credit and insurance yu get based n infrmatin in yur credit reprt. Unslicited prescreened ffers fr credit and insurance must include a tll-free phne number yu can call if yu chse t remve yur name and address frm the lists these ffers are based n. Yu may pt-ut with the natinwide credit bureaus at OPTOUT ( ). Yu may seek damages frm vilatrs. If a cnsumer reprting agency, r, in sme cases, a user f cnsumer reprts r a furnisher f infrmatin t a cnsumer reprting agency vilates the FCRA, yu may be able t sue in state r federal curt. Identity theft victims and active duty military persnnel have additinal rights. Fr mre infrmatin, visit

7 States may enfrce the FCRA, and many states have their wn cnsumer reprting laws. In sme cases, yu may have mre rights under state law. Fr mre infrmatin, cntact yur state r lcal cnsumer prtectin agency r yur state Attrney General. Federal enfrcers are: TYPE OF BUSINESS: Cnsumer reprting agencies, creditrs and thers nt listed belw CONTACT: Federal Trade Cmmissin: Cnsumer Respnse Center - FCRA, Washingtn, DC Natinal banks, federal branches/agencies f freign banks (wrd Natinal r initials N.A. appear in r after bank's name) Office f the Cmptrller f the Currency Cmpliance anagement, ail Stp 6-6 Washingtn, DC Federal Reserve System member banks (except natinal banks, and federal branches/agencies f freign banks) Federal Reserve Bard Divisin f Cnsumer & Cmmunity Affairs Washingtn, DC Savings assciatins and federally chartered savings banks (wrd Federal r initials F.S.B. appear in federal institutin's name) Office f Thrift Supervisin Cnsumer Cmplaints Washingtn, DC Federal credit unins (wrds Federal Credit Unin appear in institutin's name) Natinal Credit Unin Administratin 775 Duke Street Alexandria, VA State-chartered banks that are nt members f the Federal Reserve System Federal Depsit Insurance Crpratin Cnsumer Respnse Center, 2345 Grand Avenue, Suite 00 Kansas City, issuri Air, surface, r rail cmmn carriers regulated by frmer Civil Aernautics Bard r Interstate Cmmerce Cmmissin Department f Transprtatin, Office f Financial anagement, Washingtn, DC Activities subject t the Packers and Stckyards Act, 92 Department f Agriculture Office f Deputy Administratr GIPSA Washingtn, DC