EMPLOYMENT APPLICATION

APPLICATION FOR EMPLOYMENT

Equal Opportunity Employer: Applications for employment are considered without regard to race, religion, color, national origin, age, sex, disability, sexual orientation or veteran's status.

Date:

Position Applied for:

Refferal Source:

GENERAL APPLICANT INFORMATION:

First Name:

Middle Name:

Last Name:

Address:

City, State, Zip

Phone Number:

Email:

HAVE YOU EVER SUBMITTED AN APPLICATION OR WERE YOU PREVIOUSLY EMPLOYED WITH OUR COMPANY?

YES

ARE YOU CURRENTLY EMPLOYED?

YES

IF YES, MAY WE CONTACT YOUR EMPLOYER?

ARE YOU A UNITED STATES CITIZEN?

YES

IF NO, DO YOU HAVE A VALID WORK PERMIT?

PROOF OF CITIZENSHIP/IMMIGRATION STATUS WILL BE REQUIRED UPON EMPLOYMENT

EMPLOYMENT DESIRED:

FULL-TIME

PART-TIME

DESIRED SALARY (HOURLY/ANNUALLY)

WHAT DATE CAN YOU BEGIN EMPLOYMENT?

ARE YOU WILLING TO TRAVEL IF JOB REQUIRES IT?

YES

ARE YOU WILLING TO WORK OVERTIME IF JOB REQUIRES IT?

YES

REFERENCES: *please list two personal references.

Reference Name:

Company:

Phone Number:

Reference Name:

Company:

Phone Number:

Position:

Address:

City, State, ZIP:

Position:

Address:

City, State, ZIP:

WORK EXPERIENCE:

*List most recent employer/employment first. *List all employement for previous 10 years.

EMPLOYER NAME:

PHONE NUMBER:

SUPERVISOR/MANAGER:

DATE EMPLOYED TO:

JOB TITLE HELD/WORK PERFORMED:

EMPLOYER NAME:

PHONE NUMBER:

SUPERVISOR/MANAGER:

DATE EMPLOYED TO:

JOB TITLE HELD/WORK PERFORMED:

EMPLOYER NAME:

PHONE NUMBER:

SUPERVISOR/MANAGER:

DATE EMPLOYED TO:

JOB TITLE HELD/WORK PERFORMED:

EMPLOYER NAME:

PHONE NUMBER:

SUPERVISOR/MANAGER:

DATE EMPLOYED TO:

JOB TITLE HELD/WORK PERFORMED:

EMPLOYER NAME:

PHONE NUMBER:

SUPERVISOR/MANAGER:

DATE EMPLOYED TO:

ADDRESS:

CITY, STATE, ZIP:

DATE EMPLOYED FROM:

SALARY (ANNUAL):

REASON FOR LEAVING:

ADDRESS:

CITY, STATE, ZIP:

DATE EMPLOYED FROM:

SALARY (ANNUAL):

REASON FOR LEAVING:

ADDRESS:

CITY, STATE, ZIP:

DATE EMPLOYED FROM:

SALARY (ANNUAL):

REASON FOR LEAVING:

ADDRESS:

CITY, STATE, ZIP:

DATE EMPLOYED FROM:

SALARY (ANNUAL):

REASON FOR LEAVING:

ADDRESS:

CITY, STATE, ZIP:

DATE EMPLOYED FROM:

SALARY (ANNUAL):

EDUCATION:

TYPE OF SCHOOL

HIGH SCHOOL

COLLEGE

GRADUATE SCHOOL

BUSINESS/TRADE SCHOOL

PROFESSIONAL SCHOOL

SPECIAL HONORS

NAME OF SCHOOL

YEARS COMPLETED/DEGREE EARNED

DRIVER'S LICENSE:

Do you have a valid Driver's License?

YES

Driver's License #

Issuing State:

Any accidents in the past 3 years?

Any moving violations in the past 3 years?

Expiration Date:

DL CLASSIFICATION: Operator/CDL

How many accidents?

How many moving violations?

MILITARY STATUS (If applicable, please attach a copy of form DD214):

Are you a veteran of the United States Military Service?

Yes

If applicable, DD214 form

Upload File

Branch of Service:

Active/Reserve Duty:

Date of Discharge:

Describe any special skills or training acquired while in service:

OTHER SKILLS: In addition to your work history, please list any other skills, qualifications, or experience that we should consider.

BACKGROUND INFORMATION:

Applicants having sealed conviction records granted by court order may answer "no" to the following:

Have you been convicted of a misdemeanor?

Yes

If yes, please explain (charge, plea, disposition):

Have you been convicted of a felony?

Yes

If yes, please explain (charge, plea, disposition):

Have you ever been sued in a civil action for an intentional violation of the law?

Yes

If yes, please explain:

*Note: Answering “Yes” to any of these questions does not necessarily disqualify you from the position you are applying for. Each action and explanation will be considered in relationship to the position for which you are applying. Failure to disclose conviction/suit information will result in immediate termination if any employment offer is made.

WAIVERS AND DISCLOSURES (Please read each section carefully, initial and sign where indicated.):

AT-WILL EMPLOYMENT

It is my understanding that this employment application, or the granting of an interview, does not represent a contract of employment or a promise of future benefits by this organization. I understand and agree that, if hired, my employment will be at-will in nature and may be terminated, with or without cause, at any time by either myself or my employer. I also understand this written statement supersedes any and all oral representations made by agents or representatives of this organization.

CERTIFICATION OF TRUTH AND ACCURACY

I certify the information in this application is true, complete, and correct. I understand false answers, statements or significant omissions made by me on this form shall be sufficient cause for denial of employment or discharge/immediate termination.

NOTIFICATION AND AUTHORIZATION TO REQUIRE A MEDICAL EXAMINATION

I hereby certify, if hired, I will disclose any limitations I have which may impact my ability to perform my duties. I understand I may also be required to undergo a pre-employment or post-employment medical exam by a company designated health practitioner.

NOTIFICATION AND AUTHORIZATION TO CONDUCT A BACKROUND INVESTIGATION

I understand I may be subject to a background check, and hereby authorize Carpenter Electric, Inc. to Investigate my background to determine any and all information of concern as to my record, whether same is of record or not, and I release employers and all persons named in my application from all liability for any damages on account of his or her furnishing said information.

Additionally, you are hereby authorized to make any investigation of my personal history, educational background, military record, motor vehicle records, criminal records, and credit history through an investigative or credit agency or bureau of company’s choice. I authorize the release of this information by the appropriate agencies to the investigating service. The authorization, in original or copy form, shall be valid for this and any future reports and updates that may be required.

I understand, passing the background check is a condition of employment, with acceptable variables based on disclosure and conditions. A negative background check can be grounds for dismissal/immediate termination, even if an offer was made or if employment has begun.

Signature *Typing your name constitutes as a legal signature

Date:

DRUG AND/OR ALCOHOL TESTING CONSENT FORM

It is the policy of Carpenter Electric, Inc. (“the Company”) not to hire or retain any individuals who test positive for any illegal drug in their system, use illegal drugs or a controlled drug in any amount, regardless of frequency, without a medically acceptable prescription.

All applicants may, consistent with state law, be required to undergo a drug screening test for any or all of the following reasons:

Pre-employment purposes

Continuation of employment

Periodic, announced (routine) testing

Randomly to ensure consistency and continuance of policy

Suspicion of impairment (unusual behavior)

Post-accident (work vehicle or work-related injury)

PRE-EMPLOMENT AGREEMENT (Please read carefully):

I freely and voluntarily agree to submit to a drug test as part of my application for employment. I hereby and herewith release the Company, the medical provider obtaining the samples and the lab performing the analysis from any liability whatsoever arising from this request to furnish my urine, hair, or oral fluid, the testing of the sample and decisions made concerning my employment based upon the result of the analysis.

In the event that the employment commences prior to the Company receiving the drug test results, I understand that I will be immediately terminated if the result comes back positive, adulterated, or substituted. I understand that a negative drug test result is required for consideration for permanent employment.

I further understand that upon commencement of employment with the Company, I may again be required to submit a test of my urine, hair, or oral fluid. 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. I understand that refusal to take a requested drug test or failure to meet the minimum standards set for the drug test may result in immediate suspension or termination.

I understand that either refusal to submit to a drug test or failure to qualify according to the minimum standards established by the Company for this drug test might disqualify me from further consideration for employment.

I understand that the pre-employment drug screening process is not a job offer or employment contract, and is simply part of the application process. I have read in full and understand the above statements and conditions of employment.

I have read the above policy statement and consent form and understand and agree to submit to drug and alcohol testing as part of the terms of my employment by the Company.

Signature *Typing your name constitutes as a legal signature

Date

AUTHORIZATION FOR BACKGROUND CHECKS

I instruct and authorize Carpenter Electric, Inc. (the “Company”) to obtain a consumer report(s) (or background check report(s)) on me, including any investigative consumer reports and any consumer credit reports.* I also agree that a copy of this form is valid like the signed original.

The consumer reporting agency (CRA) ADP Screening and Selection Services, Inc. (ADP SASS) will conduct the background check and prepare the background check report for the Company. ADP SASS is located at 301 Remington Street, Fort Collins, CO, 80524, and can be reached by phone at 800-367-5933, or at www.adpselect.com.

I understand that, as allowed by applicable law, the Company may rely on this authorization to order additional background check reports, including investigative consumer reports and any consumer credit reports* (1) during my employment or time as a volunteer or independent contractor, as applicable, and (2) from any CRA other than ADP SASS without asking me for my authorization again. I understand the Company may order background check report(s) under my legal name and any other names I may have used.

I also instruct and authorize the following persons, agencies, and entities to disclose to ADP SASS and its agents all information about or concerning me, as allowed by law, including but not limited to: my past or present employers; learning institutions, including colleges and universities; law enforcement and all other federal, state and local agencies; federal, state and local courts; the military; credit bureaus; testing facilities; motor vehicle records agencies; all other private and public sector repositories of information; and any other person, organization, or agency with any information about or concerning me. As allowed by law, such disclosures may contain the following information pertaining to me: credit history*; public records; a Social Security number verification; driving records; military service; credentials/certifications; worker’s compensation injuries; and verification of prior employment and education.

*I understand that I am instructing and authorizing the Company to obtain a consumer credit report only to the extent permitted by law. If I reside or anticipate being employed in New York City, I understand that I am not being asked to authorize a consumer credit report by signing this document.

By signing below, I understand that I am agreeing to the terms contained in this document.

If you live or work for the Company in California, Minnesota or Oaklahoma: Check this box if you would like a free copy of your background check report:

First Name:

Middle:

Last Name:

Signature *Typing your name constitutes as a legal signature

Today's Date:

BACKGROUND CHECK INFORMATION:

The information requested below is collected solely for the purpose of aiding the Consumer Reporting Agency (CRA) in completing a background check on you.

First Name:

Middle Name

Last Name:

Suffix

Email Address:

For Identification Purposes Only: Date of Birth

Driver's License Number:

State Issuing License:

Enter Nickname(s) Used:

Enter Any Other Names Used (including maiden names):

First Name:

Middle Name:

Last Name:

Addresses within the Past Seven Years (use a separate sheet as needed)

Present Street Address:

Prior Street Address:

From (Month/Day/Year)

Prior Street Address 2:

From (Month/Day/Year)

City/State/ZIP

To (Month/Day/Year)

City/State/ZIP

To (Month/Day/Year)

MOTOR VEHICLE INFORMATION RELEASE FORM:

I hereby authorize Carpenter Electric, Inc. and it’s Agent, CBIZ Weekes Callaway, Inc. to receive any motor vehicle report or driving history record pertaining to my driving record, annually, which may be in the files of my State or local department of Motor Vehicle Agency.

First Name:

Middle Name:

Email Address:

Driver's License Number:

Signature *Typing your name constitutes as a legal signature

Last Name:

Suffix:

For Identification Purposes Only: Date of Birth

State Issuing License

Date:

I have read, and do hereby accept the terms and conditions contained in these disclosures.

Thanks for submitting!

EMPLOYMENT APPLICATION

APPLICATION FOR EMPLOYMENT

GENERAL APPLICANT INFORMATION:

PROOF OF CITIZENSHIP/IMMIGRATION STATUS WILL BE REQUIRED UPON EMPLOYMENT

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EMPLOYMENT APPLICATION

APPLICATION FOR EMPLOYMENT

GENERAL APPLICANT INFORMATION:

*PROOF OF CITIZENSHIP/IMMIGRATION STATUS WILL BE REQUIRED UPON EMPLOYMENT*

PROOF OF CITIZENSHIP/IMMIGRATION STATUS WILL BE REQUIRED UPON EMPLOYMENT