EMPLOYMENT APPLICATION

Transcription

1 301 Church Avenue, Knoxville TN APPLICANT INSTRUCTIONS: If you need assistance filling out this application form please contact KAT at (865) Please read "APPLICANT NOTE" below. 2. Complete the two-page employment application. If more space is needed to complete any question, use comments section at the bottom of the back page. 3. Print clearly; incomplete or illegible applications will not be processed. Please note "t Applicable" if not answering a question. 4. Complete other referenced, posted or attached forms. 5. Bring completed employment application and other forms with original signatures to KAT s Human Resources department at 301 Church Avenue, Knoxville, TN Please do not mail applications to this address. APPLICANT NOTE: EMPLOYMENT APPLICATION TODAY'S DATE: POSITION APPLIED FOR: NAME: SOCIAL SECURITY NUMBER: HOME PHONE: CURRENT ADDRESS: LAST FIRST M.I. STREET WORK PHONE: CITY STATE ZIP This application form is intended for use in evaluating your qualifications for employment. This is not an employment contract. Please answer all appropriate questions completely and accurately. False or misleading statements during the interview and on this form are grounds for terminating the application process or, if discovered after employment, terminating employment. All qualified applicants will receive consideration without discrimination because of sex, marital status, race, color, age, creed, national origin, sexual orientations, military reserve membership, ancestry, religion, height, weight, use of a guide or support animal because of blindness, deafness or physical handicap, or the presence of disabilities. A felony conviction will not necessarily bar an applicant from employment. Additional testing of job-related skills and for the presence of drugs in your body will be required prior to employment. After an offer of employment, and prior to reporting to work, you will be required to submit to a medical review. Depending on company policy and the needs of the job, you will be required to complete a medical history form and will be required to be examined by a medical professional designated by the company. For which position are you applying? What date can you start? What category would you prefer? For which schedules are you available? If the job requires, do you have the appropriate valid drivers license? Are you legally eligible for employment in this country? Are you able to meet the attendance requirements of the position? Will you work overtime if required? Full-time Have you ever been discharged or asked to resign any job? Do you have any relatives presently working for KAT? Weekdays Have you ever been employed by this company before? List states and counties of residence for the past seven years: Part-time Weekends Temporary Evenings/Nights Name on license D.L. # Type of License Have you had any moving violations in the past three years? Have you had any traffic accidents in the the past three years? Has your license to operate a motor vehicle ever been revoked, suspended or cancelled? If yes, relative's name/how related: Overtime Other Have you used any names or Social Security Number other than given above? If so, please list in comments, below. Have you been convicted of a crime in the past seven years? If so, please describe in the boxes below. Conviction will not necessarily be a bar to employment. (In accordance with company policy and applicable state and federal laws, factors such as age at time of the offense, remoteness of the offense, time since last conviction, nature of the job sought and rehabilitation effort will be reviewed.) INCIDENT CITY/STATE CHARGE PLEASE NOTE: Your application will not be considered unless every question in this section is answered. (continued on back)

2 (application form continued from front): page 2 EDUCATION: Please circle the highest grade completed: PREVIOUS EMPLOYERS: Since we will make every effort to contact previous employers, the correct telephone numbers of past employers are critical. Ask for a phone book or call information if you need. FOR EMPLOYERS OUTSIDE THE UNITED STATES, A CURRENT FAX NUMBER IS MANDATORY. MOST RECENT EMPLOYER Are you currently working for this employer? If yes, may we contact? PHONE ( ) FAX ( ) COMPANY NAME CITY STATE FROM TO DATE EMPLOYED JOB TITLE SUPERVISOR NAME DUTIES PER SALARY (HOUR, WEEK MONTH) REASON FOR LEAVING SECOND MOST RECENT EMPLOYER Are you currently working for this employer? If yes, may we contact? PHONE ( ) FAX ( ) COMPANY NAME CITY STATE FROM TO DATE EMPLOYED JOB TITLE SUPERVISOR NAME DUTIES PER SALARY (HOUR, WEEK MONTH) REASON FOR LEAVING THIRD MOST RECENT EMPLOYER Are you currently working for this employer? If yes, may we contact? PHONE ( ) FAX ( ) COMPANY NAME CITY STATE FROM TO DATE EMPLOYED JOB TITLE SUPERVISOR NAME DUTIES PER SALARY (HOUR, WEEK MONTH) REASON FOR LEAVING REFERENCES: NAME ADDRESS/PHONE YEARS KNOWN/RELATIONSHIP COMMENTS: (add additional page if necessary) CERTIFICATION AND RELEASE: I certify that I have read and understand the application note on this form and that the answers given by me to the foregoing information, omissions or misrepresentations of facts called for in this application, whether on this document or not, may result in rejection of my application or discharge at any time during my employment. I authorize the company and/or its agents, including consumer reporting bureaus, to verify any of this information. I authorize all former employers, persons, schools, companies and law enforcement authorities to release any information concerning my background and hereby release any said persons, schools, companies and law enforcement authorities from any liability for any damage whatsoever for issuing this information. I also understand that the use of illegal drugs is prohibited during employment. I will to submit to drug testing to detect the use of illegal drugs prior to and during employment. I understand that KAT does not employ immediate family members and/or ex-spouses of its employees. Immediate family members are defined as legal parent, child, brother, sister and spouse. Extended family members including aunts, uncles, grandparents, first cousins and domestic partnerships with a KAT employee must also be identified. Failure to identify these relationships may result in dismissal after employment at KAT. SIGNATURE Revised: 3/2010 DATE

3 RELEASE AUTHORIZATION In connection with my application for employment, I understand that a consumer and/or investigative report will be requested that will include information as to my character, work habits, performance, and experience, along with reasons for termination of past employment. I understand that as directed by company policy and consistent with the job described, KAT may be requesting information from public and private sources about my: workers comp injuries; driving record; court record; education; credentials; credit and references. I will submit to drug testing to detect the use of controlled substances prior to and during employment. Medical and workers comp information will only be requested in compliance with the Federal Americans with Disabilities Act and/or any other applicable state laws. According to the Fair Credit Reporting Act, I am entitled to know if employment is denied because of information obtained by my prospective employer from a consumer reporting agency. If so, I will be notified and given the name and address of the agency or the source which provided the information. I acknowledge that a facsimile (fax) or photographic copy shall be as valid as the original. This release is valid for most federal, state and county agencies. I hereby authorize, without reservation, any law enforcement agency, institution, information service bureau, school, employer, reference or insurance company contacted by K-TRANS Management Inc. or its agent, to furnish the information described above. The following represents information required by law enforcement agencies and other entities for positive identification purposes when checking public records. It is confidential and will not be used for any other purpose. I hereby release the employer and agents and all persons, agencies, and entities providing information or reports about me from any and all liability arising out of the requests for or release of any of the above mentioned information or reports. Print full name: Print any other names used: Home address: City/State/Zip: SSN DOB Drivers License # Signature Date:

4 DISCLOSURE TO EMPLOYMENT APPLICANT REGARDING PROCUREMENT OF A CONSUMER REPORT In connection with your application for employment, we will procure a consumer report on you as part of the process of considering your candidacy as an employee. In the event that information from the report is utilized in whole or in part in making an adverse decision with regard to your potential employment you will be provided with a copy of the report, at your request. Please be advised that we may also obtain an investigative report including information as to your character, general reputation, personal characteristics, and mode of living. This information may be obtained by contacting your previous employers or references supplied by you. Please be advised that you have the right to request, in writing, within a reasonable time, that we make a complete and accurate disclosure of the nature and scope of the information requested. Such disclosure will be made to you within five days of the date on which we receive the written request from you.the Fair Credit Reporting Act gives you specific rights in dealing with consumer reporting agencies. By your signature below, you hereby authorize KAT to obtain a consumer report about you in order to consider you for employment. Name: Address: City/State/Zip: Signature: Social Security #

5 CONSENT FOR ALCOHOL/DRUG ANALYSIS AND RELEASE OF MEDICAL RECORDS I hereby authorize the collection of a urine sample for the purpose of determining the presence of alcohol and/or drugs in my system. I understand that employment with KAT is contingent upon collection of this sample and that a subsequent detection of alcohol and/or drugs will result in the immediate withdrawal of any offer of employment. Additionally, I understand that a positive drug and/or alcohol screen or a refusal to test from a previous employer within the past two years will also result in an immediate withdrawal of any offer of employment. I hereby give my consent for the release of these test results and other relevent medical information to the KAT company doctor and for appropriate review with KAT Human Resources Manager, or Chief Operating Officer. I understand that KAT will not accept results from previous employers as a substitute for this screening. I further understand that my refusal to submit to a drug and/or alcohol analysis or the required physical evaluation will result in the withdrawal of any offer of employment with KAT. The urine sample being collected will be tested for evidence of (1) marijuana; (2) cocaine; (3) opiates; (4) phencyclidine (PCP); and (5) amphetamines. AUTHORIZATION AGREED AUTHORIZATION DENIED DATE DATE

6 COMMERCIAL DRIVERS LICENSE I am aware that many jobs at KAT require a State of Tennessee Commercial Drivers License, Class B with a passenger endorsement and that, while KAT will train me for the license, it is my responsibility to acquire said license. Additionally, I understand that until I obtain the appropriate license, I will passed over in seniority in favor of someone hired after me who is in possession of the required license. Furthermore, I understand that if, for any reason, my training takes longer than those hired on or around my hire date, I will be passed over in seniority in favor of those who have completed the training. Signed: Date: 03.10

7 DRIVERS BACKGROUND CHECK CONSENT K N O X V I L L E I,, hereby authorize, without reservation, KAT, any agent of KAT and/or any law enforcement agency to check my drivers license record and to obtain a copy of this record. I understand this is necessary in order to maintain the current status of my license and address information. This permission is granted for the above as often as deemed necessary by KAT. Signed: Date: