NATIONAL COPPER & SMELTING, CO. Application for Employment This application form is considered current for 6 months. At the end of this period, if you are still interested in employment, it will be necessary for you to reapply by filling out a new application. *Incomplete applications will not be considered. Date: Full Name: Address: Last First Middle Nickname Street City State Zip Code Telephone Number: ( ) - Social Security #: - - Email Address: Person to Notify in Case of Emergency: Relationship: Telephone Number: ( ) - Have you ever worked for National Copper? If yes, when? From: To: Friends/Relatives Employed at National Copper: Referred to National Copper by: Relationship: Relationship: Are you a U.S. Citizen? If not, are you legally permitted to work in the U.S.? (Consideration for employment is contingent on providing proof of citizenship or work authorization.) Are you 18 years of age or older? Have you ever been convicted of a crime other than a misdemeanor? If yes, please state the date, place and nature of conviction: Can you use: Calipers Micrometers? Name any other precision tooling you have experience with: Can you operate a forklift? Have you been licensed to operate a forklift? Do you have any specific machine experience? If so, please describe: Have you ever been terminated due to unsatisfactory conduct or job performance? If yes, name of employer: What days of the week are you avaialble for work? Mon. Tues. Wed. Thurs. Fri. Sat. Sun What shifts/hours are you avaialble to work?: 12 HOUR SHIFT: 8 HOUR SHIFT: DAY NIGHT 1ST 2ND 3RD Are you available and willing to work overtime? When would you be available to begin work? 1 of 6
EMPLOYMENT HISTORY Give a complete account of your employment. Begin at the top with present or most recent position and work back in time. Use back of application if more space is needed. Incomplete applications may not be considered. PHONE. PHONE. PHONE. PHONE. May we contact your present employer? May we contact your past employers? FOR OFFICE USE ONLY: 2 of 6
EDUCATION AND TRAINING HIGH SCHOOL LAST ATTENDED: Did you graduate? GED received? Year: VOCATIONAL, TECHNICAL, JR. COLLEGE: Number of Years Completed: Last Year Attended: Graduated: Major: Minor: COLLEGE OR UNIVERSITY Number of Years Completed: Last Year Attended: Graduated: Major: Minor: OTHER TRAINING (INCLUDING MILITARY, EQUIVALENCY DIPLOMAS, ETC.): Number of Years Completed: Last Year Attended: Graduated: Major: Minor: MILITARY SERVICE: Have you served in the U.S. Military? From: / To: / Branch: Primary Duties: Date of Separation: Reserve or National Guard Status: ACTIVE INACTIVE Involved in Summer Training? 3 of 6
GENERAL I understand that acceptance of an offer of employment created no obligation upon the employer to continue my employment in the future. Employment with National Copper is based on the consent of both the company and the individual. Therefore, both the individual and the company have the freedom to terminate employment whenever either chooses to do so. I submit this application to national Copper & Smelting Company, Inc. With full Knowledge, understanding, and consent of the following: 1. I agree, if employed, to abide by all rules and regulations of National Copper & Smeling Company, Inc. 2. If employed, I understand that I will be solely responsible for the care of any equipment issued to me by National Copper & Smelting. With this responsibility in mind, I authorize National Copper & Smelting Company, Inc. to deduct from my wages, the amount necessary to replace any equipment lost or destroyed through my negligence or misuse. 3. I understand that an incomplete and/or unsigned application may not be considered for employment. 4. I certify that all statements contained in this application are complete, accurate and truthful, and authorize investigation of said statements. I understand that any false or misleading statements may be cause for rejection of my application and/or if employed, may be just cause for subsequent dismissal. 5. I authorize my former employers/representatives to release any information concerning my former employment with them, and agree to hold said former employers/representatives harmless for the release of said information. A photocopy and/or fax of this signed authorization shall have the same effect as the original. APPLICANT'S SIGNATURE DATE PRINT APPLICANT'S NAME 4 of 6
FOR OFFICE USE ONLY: Offered job: Refused (Date): Employee Number: Accepted (Date): Employment Date: Physical Date: 1. BACKGROUND AND PURPOSE National Copper & Smelting Company is an equal opportunity employer. Our policy prohibits, among other things, any form of discrimination against persons with disabilities. The Americans with Disibilities Act of 1990 (ADA) prohibits discrimination against persons with disabilities in hiring as well as in all terms and conditions of employment. Employers are required to make reasonable accommodations for all know impairments to ensure equal opportunity in the application process, and to enable employees with disabilities to perform the essential functions of the job and enjoy the same benefits and privileges of employment as are enjoyed by employees without disabilities. In order for a person to obtain the protections offered by the ADA, an individual must have a physical or mental impairment that substantially limits one or more major life activities, have a record of such impairment, or be regarded as having such an impairment. We need your assistance to help us ensure the proper placement and accommodation of all applicants and employees who have a disability. 2. VOLUNTARY SUBMISSION AND CONFIDENTIALITY Submission of the information requested in this form is completely voluntary, and you will not be discharged, disciplined or subjected to any other adverse treatment if you do not provide the information. The information
BACKGROUND CHECK PERMISSION (COMPREHENSIVE) FOR PROSPECTIVE EMPLOYEE In connection with my application for employment with National Copper & Smelting (the "Company"), I hereby agree as follows: 1. GENERAL CONSENT TO BACKGROUND INVESTIGATION As a condition of Company's consideration of my employment application, I give permission to Company to investigate my personal and employment history. I understand that this background investigation will include, but not be limited to, verification of all information on my employment application. 2. CONSENT TO CONTACT PAST EMPLOYERS I specifically give permission to Company to contact all of my prior employers for references. I further give permission to all current or previous employers and/or managers or supervisors to discuss my relevant personal and employment history with Company, consent to the release of such information orally or in writing, and hereby release them from all liability and agree not to sue them for defamation or other claims based upon any statements they make to any representative of Company. I further waive all rights I may have under law to receive a copy of any written statement provided by any of my former employers to Company. I further agree to indemnify all past employers for any liability they may incur because of their reliance upon this Agreement. 3. CONSENT TO CONTACT GOVERNMENT AGENCIES I further give permission to the Company to receive a copy of any information obtained in the file of any federal, state, or local court, or governmental agency concerning or relating to me. I further consent to the release of such information and waive any right under law concerning notification of the request for a release of such information. In the event a law does not provide for prospective employers to have access to information, I hereby delegate Company as my agent for the receipt of information. I understand that the scope of this investigation will be limited as required by applicable law. 4. COOPERATION WITH INVESTIGATION I agree to fully cooperate in Company's background investigation, and to sign any waivers or releases that may be necessary or desirable to obtain access to relevant information. In the event that any former employer or federal, state, or local governmental agency will not release reference information or criminal history information directly to the employer, I agree to personally request such information to the extent permitted by law. (APPLICANT SIGNATURE) (PRINT NAME) Date: 6 of 6