Employment Application

Transcription

1 14 REGIONAL LOCATIONS Newport, KY - Headquarters Employment Application Art s Rental Equipment & Supply considers all applicants based upon personal capabilities and qualifications without regard to race, color, religion, sex, age, national origin, disability, or any other protected characteristics as established by law. SECTION A: PERSONAL INFORMATION Desired Position Complete All Applicable Information. Date of Application Last Name First Name Middle Name Street Address City State Zip Code Telephone Number (Primary) Telephone Number (Alternate) SECTION B: GENERAL Are you interested in Full Time Part Time Temporary If offered a position, when are you available to start? Desired Annual Salary/Wages How were you referred to us? Newspaper Radio Employment Agency Friend/Relative Personal Inquiry Other: Are you legally authorized to work in the United States? If hired, can you provide proof of your eligibility to work in the United States? Are you 18 years of age or older? Have you ever been convicted of a felony? (Answering will not automatically disqualify you from employment.) Have you ever applied for employment with Art s Rental Equipment & Supply before? If yes, please provide the date / / Has the company ever employed you before? If yes, please provide the date / / Are you available to work overtime? Do you have any friends or relatives working at Art s Rental Equipment & Supply? If yes, who? Driving Positions Only: Do you have a valid driver s license?

2 SECTION C: EDUCATION School High School Name and Location Course of Study Years Completed Degree/Diploma College Graduate Other (Specify) SECTION D: MILITARY SERVICE Were you in the U.S. Military? If yes, what branch Rank at time of discharge Have you had any job-related training in the military? If yes, please describe SECTION E: EMPLOYMENT HISTORY List your last three employers, starting with your most recent first. Name of Company Address Supervisor Title of Supervisor Phone Last Position Duties Dates Employed Wage/Salary Other Compensation From To Starting Final Bonus Commission Reason for leaving Name of Company Address Supervisor Title of Supervisor Phone Last Position Duties Dates Employed Wage/Salary Other Compensation From To Starting Final Bonus Commission Reason for leaving Name of Company Address Supervisor Title of Supervisor Phone Last Position Duties Dates Employed Wage/Salary Other Compensation From To Starting Final Bonus Commission Reason for leaving

3 SECTION F: Personal/Professional References Do not include family members or past supervisors. Name Phone Number Best Time to Call Occupation SECTION G: Provide an explanation for any gaps in your employment. SECTION H: Describe any additional training or specialized skills. SECTION I: Applicant s Statement Please read the following statements carefully. I, the undersigned, understand that I am being considered as a potential employee of ART S RENTAL EQUIPMENT & SUPPLY and hereby certify that: 1. In consideration of my employment, I agree to conform to the policies and procedures of the Company. I understand that in accepting this application, ART S RENTAL EQUIPMENT & SUPPLY is in no way obligated to provide me with employment and I am not obligated to accept employment if offered. 2. I understand that if I am hired, such hiring will not be for any definite period of time. Futhermore, I understand, that if I am hired, I will be an employee at-will and I can be terminated at any time, with or without cause and with or without notice. 3. I understand that my status as an at-will employee, and the terms and conditions of that employment cannot be changed except in writing and signed by the President of ART S RENTAL EQUIPMENT & SUPPLY. 4. I certify that the facts contained in this application are true and complete to the best of my knowledge. I understand that any falsified statements on this application or omission of fact either on this application or during the pre-employment process will result in my application being rejected, or, if I am hired, in my employment being terminated. 5. I also understand that any offer of employment is conditioned on the completion of pre-employment tests and documentation. I will, upon request, sign all necessary consent forms. Signature of Applicant Date OFFICE USE ONLY / / Applicant Hired: If, Start Date: Starting Salary/Wage: /per year/hour

4 Authorization to Conduct Background Checks In connection with my application for employment with Art s Rental Equipment & Supply (the Company ), I hereby agree as follows: 1. GENERAL CONSENT TO BACKGROUND IVESTIGATION 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 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 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. In the event a law does not provide 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.

5 5. FCRA AUTHORIZATION I understand that, as a condition of my consideration for employment with Company, or as a condition of my continued employment with Company, Company may obtain a consumer report that includes, but is not limited to, my creditworthiness or similar characteristics, employment and education verifications, social security verification, criminal and civil history, personal interviews, BMV records, any other public records and any other information bearing on my credit standing, credit capacity, character, general reputation, personal characteristics and trustworthiness. I hereby authorize and consent to Company s procurement of such a report, I understand that, pursuant to the federal Fair Credit Reporting Act, Company will provide me with a copy of any such report if the information contained in such report is, in any way, to be used in making a decision regarding my fitness for employment with Company. I further understand that such report will be made available to me prior to any such decision being made, along with the name and address of the reporting agency that produced the report. 6. MISCELLANEOUS This agreement represents the entire understanding and agreement relating to its subject matter. Company shall be entitled fully to rely on this Agreement. I understand that I have no guarantee of employment and that the Company may determine not to hire me for any lawful reason. Applicant s Signature Date Applicant s Printed Name Social Security Number Birth Date

6 DISCLOSURE AND AUTHORIZATION TO OBTAIN CONSUMER REPORT AND/OR INVESTIGATIVE CONSUMER REPORT AND RELEASE In connection with my application for employment with (including contract for services), (YOUR COMPANY NAME, CITY and STATE) and at any time during any subsequent employment, I understand that consumer reports which may contain public record information may be requested from G4S Compliance & Investigations, 3950 RCA Blvd., Suite 5003, Palm Beach Gardens, Florida 33410, These reports may include the following types of information: names and dates of previous employers, reason for termination of employment, work experience, accidents, drugs/alcohol use. I further understand that such reports may contain public record information concerning my driving record, workers' compensation claims, credit, bankruptcy proceedings, criminal records, etc., from federal, state and other agencies which maintain such records, in addition to employment, educational verification and personal references. I AUTHORIZE, WITHOUT RESERVATION, ANY PARTY OR AGENCY CONTACTED BY G4S TO FURNISH THE ABOVE- MENTIONED INFORMATION. (A facsimile of this authorization will be construed valid) I have the right to make a request to G4S, upon proper identification, to request the nature and substance of all information in its files on me at the time of my request, including the sources of information; and the recipients of any reports on me which G4S has previously furnished within the two-year period preceding my request. I hereby consent to your obtaining the above information from G4S. I hereby authorize procurement of consumer report(s). If hired (or contracted), this authorization shall remain on file and shall serve as ongoing authorization for you to procure consumer reports at any time during my employment (or contract) period. Print Applicant's Name Applicant's Signature Social Security Number Month and Day of Birth (DO NOT PUT YEAR OF BIRTH) Today's Date tice to California Applicants: Under California law, the consumer reports we order on you are defined as investigative consumer reports. These reports may contain information on your character, general reputation, personal characteristics and mode of living. YES, I am a California Applicant and I request to receive a free copy of any investigative consumer report ordered on me by checking this box. Under section of the California Civil Code, you may view the file maintained on you by G4S Secure Solutions (USA) Inc. during normal business hours. You may also obtain a copy of this file upon submitting proper identification and paying the costs of duplication services, by appearing at G4S Secure Solutions (USA) Inc. in person or by mail. You may also receive a summary of the file by telephone. The agency is required to have personnel available to explain your file to you and the agency must explain to you any coded information appearing in your file. If you appear in person, a person of your choice may accompany you, provided that this person furnishes proper identification. MN & OK Residents please note: In connection with your application for employment, your consumer credit report will be obtained and reviewed. Under MN law, if a credit report is requested, you have a right to receive a free copy of your credit report by checking the appropriate box below. Under OK law, you have the right to receive a free copy of your consumer report directly from G4S Secure Solutions (USA) Inc. YES, I am a Minnesota resident and would like a free copy of my credit report. YES, I am an Oklahoma resident and would like a free copy of my consumer report. WF-078a (05/09/11) Page 1 of 5

7 A Summary of Your Rights Under the Fair Credit Reporting Act The federal Fair Credit Reporting Act (FCRA) is designed to promote accuracy, fairness, and privacy of information in the files of every ''consumer reporting agency'' (CRA). Most CRAs are credit bureaus that gather and sell information about you - such as it you pay your bills on time or have filed bankruptcy- to creditors, employers, landlords, and other businesses. YOU can find the complete text of the FCRA, 15 U.S.C u, at the Federal Trade Commission's web site ( The FCRA gives you specific rights, as outlined below. YOU may have additional rights under state law. YOU may contact a state or local consumer protection agency or a state attorney general to learn those rights. You must be told if information in your file has been used against you. Anyone who uses information from a CRA to take action against you -- such as denying an application for credit, insurance, or employment -- must tell you, and give you the name, address, and phone number of the CRA that provided the consumer report. You can find out what is in your file. At your request, a CRA must give you the information in your file, and a list of everyone who has requested it recently, There is no charge for the report if a person has taken action against you because of information supplied by the CRA, it you request the report within 60 days of receiving notice of the action. You also are entitled to one free report every twelve months upon request it you certify that (1) you are unemployed and plan to seek employment within 60 days, (2) you are on welfare, or (3) your report is inaccurate due to fraud- otherwise, a CRA may charge you up to eight dollars. You can dispute inaccurate information with the CRA. If You tell a CRA that your file contains inaccurate information, the CRA must investigate the items (usually within 30 days) by presenting to its information source all relevant evidence you submit, unless your dispute is frivolous. The source must review your evidence and report its findings to the CRA. (The source also must advise national CRAS -- to which it has provided the data -- of any error.) The CRA must give you a written report of the investigation and a copy of your report if the investigation results in any change. If the CRA's investigation does not resolve the dispute, you may add a brief statement to your file. The CRA must normally include a summary of your statement in future reports. If an item is deleted or a dispute statement is filed, you may ask that anyone who has recently received your report be notified of the change. Inaccurate information must be corrected or deleted. A CRA must remove or correct inaccurate or unverified information from its files, usually within 30 days after you dispute it. However, the CRA is not required to remove accurate data from your file unless it is outdated (as described below) or cannot be verified. If your dispute results in any change to your report, the CRA cannot reinsert into your file a disputed item unless the information source verities its accuracy and completeness. In addition, the CRA must give you a written notice telling you it has reinserted the item. The notice must include the name, address and phone number of the information source. You can dispute inaccurate items with the source of the information. if you tell anyone -- such as a creditor who reports to a CRA -- that you dispute an item, they may not then report the information to a CRA without including a notice of your dispute. In addition, once you've notified the source of the error in writing, it may not continue to report the information if it is, in fact, an error. Outdated information may not be reported. In most cases, a CRA may not report negative information that is more than seven years old; ten years for bankruptcies. Access to your file is limited. A CRA may provide information about you only to people with a need recognized by the FCRA -- usually to consider an application with a creditor, insurer, employer, landlord, or other business. WF-078a (05/09/11) Page 2 of 5

8 Your consent is required for reports that are provided to employers, or reports that contain medical information. A CRA may not give out information about you to your employer, or prospective employer, without your written consent. A CRA may not report medical information about you to creditors, insurers, or employers without your permission. You may choose to exclude your name from CRA lists for unsolicited credit and insurance offers. Creditors and insurers may use file information as the basis for sending you unsolicited offers of credit or insurance. Such offers must include a toll-free phone number for you to call if you want your name and address removed from future lists. If you call, you must be kept off the lists for two years. If you request, complete, and return the CRA form provided for this purpose, you must be taken off the lists indefinitely. You may seek damages from violators. If a CRA, a user or (in some cases) a provider of CRA data, violates the FCRA, you may sue them in state or federal court. The FCRA gives several different federal agencies authority to enforce the FCRA: FOR QUESTIONS OR CONCERNS REGARDING: PLEASE CONTACT: CRAs, creditors and others not listed below Federal Trade Commission Consumer Response Center - FCRA Washington, DC National banks, federal branches/agencies of foreign banks (word ''National'' or initials ''N.A.'' appear in or after bank's name) Office of the Comptroller of the Currency Compliance Management, Mail Stop 6-6 Washington, DC Federal Reserve System member banks (except national banks, and federal branches/agencies of foreign banks) Federal Reserve Board Division of Consumer & Community Affairs Washington, DC Savings associations and federally chartered savings banks (word ''Federal'' or initials "F.S.B." appear in federal institution's name) Federal credit unions (words ''Federal Credit Union'' appear in institution's name) State-chartered banks that are not members of the Federal Reserve System Air, surface, or rail common carriers regulated by former Civil Aeronautics Board or Interstate Commerce Commission Activities subject to the Packers and Stockyards Act, 1921 Office of Thrift Supervision Consumer Programs Washington, DC National Credit Union Administration 1775 Duke Street Alexandria, VA Federal Deposit Insurance Corporation Division of Compliance & Consumer Affairs Washington, DC FDIC Department of Transportation Office of Financial Management Washington, DC Department of Agriculture Office of Deputy Administrator - GI PSA Washington, DC WF-078a (05/09/11) Page 3 of 5

9 New Jersey and Washington State Addendum to A Summary of Your Rights Under the Fair Credit Reporting Act For residents of Washington State: A SUMMARY OF YOUR RIGHTS UNDER THE STATE OF WASHINGTON FAIR CREDIT REPORTING ACT: The State of Washington Fair Credit Reporting Act (WFCRA) is designed to promote accuracy, fairness, consumer confidentiality and the proper use of credit data by each consumer reporting agency (''CRA'') in accordance with the requirements of the WFCRA. The WFCRA is modeled after the Federal Fair Credit Reporting Act. You have received A Summary of Your Rights Under the Federal Fair Credit Reporting Act. The two Acts are almost identical as are your rights under them. You can find the complete text of WFCRA RCW , at the nearest office of the Washington State Attorney General. You may seek damages from violators. If a CRA, a user or (in some cases) a provider of CRA data violates the WFCRA, you may sue them in court. For questions or concerns regarding the WFCRA, please contact: Attorney General of the State of Washington 1125 Washington Street S. E. P.O. Box Olympia, WA Phone: For residents of New Jersey, A SUMMARY OF YOUR RIGHTS UNDER THE STATE OF NEW JERSEY: The state of New Jersey Fair Credit Reporting Act (NJFCRA) is designed to promote accuracy, fairness, consumer confidentiality and the proper use of credit data by each consumer reporting agency (''CRA'') in accordance with the requirements of the NJFCRA. The NJFCRA is modeled after the Federal Fair Credit Reporting Act. You have received A Summary of Your Rights Under the Federal Fair Credit Reporting Act. The two Acts are almost identical, as are your rights under them. You can find the complete text of the NJFCRA at the Department of Consumer Affairs. You may seek damages from violators. If a CRA, a user or (in some cases) a provider of CRA data violates the NJFCRA, you may sue them in court. For questions or concerns regarding the NJFCRA, please contact: Division of Consumer Affairs Department of Law and Public Safety 124 Halsey Street Newark, NJ Phone: WF-078a (05/09/11) Page 4 of 5

10 New York State Addendum to A Summary of Your Rights Under the Fair Credit Reporting Act For residents of New York State: A SUMMARY OF YOUR RIGHTS UNDER THE STATE OF NEW YORK CORRECTION LAW ARTICLE 23-A: LICENSURE AND EMPLOYMENT OF PERSONS PREVIOUSLY CONVICTED OF ONE OR MORE CRIMINAL OFFENSES 750. Definitions. For the purposes of this article, the following terms shall have the following meanings: (1) "Public agency" means the state or any local subdivision thereof, or any state or local department, agency, board or commission. (2) "Private employer" means any person, company, corporation, labor organization or association which employs ten or more persons. (3) "Direct relationship" means that the nature of criminal conduct for which the person was convicted has a direct bearing on his fitness or ability to perform one or more of the duties or responsibilities necessarily related to the license, opportunity, or job in question. (4) "License" means any certificate, license, permit or grant of permission required by the laws of this state, its political subdivisions or instrumentalities as a condition for the lawful practice of any occupation, employment, trade, vocation, business, or profession. Provided, however, that "license" shall not, for the purposes of this article, include any license or permit to own, possess, carry, or fire any explosive, pistol, handgun, rifle, shotgun, or other firearm. (5) "Employment" means any occupation, vocation or employment, or any form of vocational or educational training. Provided, however, that "employment" shall not, for the purposes of this article, include membership in any law enforcement agency Applicability. The provisions of this article shall apply to any application by any person for a license or employment at any public or private employer, who has previously been convicted of one or more criminal offenses in this state or in any other jurisdiction, and to any license or employment held by any person whose conviction of one or more criminal offenses in this state or in any other jurisdiction preceded such employment or granting of a license, except where a mandatory forfeiture, disability or bar to employment is imposed by law, and has not been removed by an executive pardon, certificate of relief from disabilities or certificate of good conduct. thing in this article shall be construed to affect any right an employer may have with respect to an intentional misrepresentation in connection with an application for employment made by a prospective employee or previously made by a current employee Unfair discrimination against persons previously convicted of one or more criminal offenses prohibited. application for any license or employment, and no employment or license held by an individual, to which the provisions of this article are applicable, shall be denied or acted upon adversely by reason of the individual's having been previously convicted of one or more criminal offenses, or by reason of a finding of lack of "good moral character" when such finding is based upon the fact that the individual has previously been convicted of one or more criminal offenses, unless: (1) There is a direct relationship between one or more of the previous criminal offenses and the specific license or employment sought or held by the individual; or (2) the issuance or continuation of the license or the granting or continuation of the employment would involve an unreasonable risk to property or to the safety or welfare of specific individuals or the general public Factors to be considered concerning a previous criminal conviction; presumption. 1. In making a determination pursuant to section seven hundred fifty-two of this chapter, the public agency or private employer shall consider the following factors: (a) The public policy of this state, as expressed in this act, to encourage the licensure and employment of persons previously convicted of one or more criminal offenses. (b) The specific duties and responsibilities necessarily related to the license or employment sought or held by the person. (c) The bearing, if any, the criminal offense or offenses for which the person was previously convicted will have on his fitness or ability to perform one or more such duties or responsibilities. (d) The time which has elapsed since the occurrence of the criminal offense or offenses. (e) The age of the person at the time of occurrence of the criminal offense or offenses. (f) The seriousness of the offense or offenses. (g) Any information produced by the person, or produced on his behalf, in regard to his rehabilitation and good conduct. (h) The legitimate interest of the public agency or private employer in protecting property, and the safety and welfare of specific individuals or the general public. 2. In making a determination pursuant to section seven hundred fifty-two of this chapter, the public agency or private employer shall also give consideration to a certificate of relief from disabilities or a certificate of good conduct issued to the applicant, which certificate shall create a presumption of rehabilitation in regard to the offense or offenses specified therein Written statement upon denial of license or employment. At the request of any person previously convicted of one or more criminal offenses who has been denied a license or employment, a public agency or private employer shall provide, within thirty days of a request, a written statement setting forth the reasons for such denial Enforcement. 1. In relation to actions by public agencies, the provisions of this article shall be enforceable by a proceeding brought pursuant to article seventy-eight of the civil practice law and rules. 2. In relation to actions by private employers, the provisions of this article shall be enforceable by the division of human rights pursuant to the powers and procedures set forth in article fifteen of the executive law, and, concurrently, by the New York city commission on human rights. WF-078a (05/09/11) Page 5 of 5