EMPLOYMENT APPLICATION

Transcription

1 POSITION(S) YOU ARE APPLYING FOR EMPLOYMENT APPLICATION Sioux Falls Construction DATE OF APPLICATION PERSONAL INFORMATION (please print) NAME (Last, First, Middle Initial) PHONE PERSONAL HOW DID YOU LEARN ABOUT THE JOB OPENING YOU ARE APPLYING FOR? REQUESTED WAGE RANGE FROM: TO: WILL YOU TAKE AN ALCOHOL / DRUG SCREENING TEST Yes No ARE YOU 18 YEARS OF AGE OR OLDER? Yes No ARE YOU CURRENTLY EMPLOYED? Yes No MAY WE CONTACT YOUR CURRENT EMPLOYER? Yes No WHEN COULD YOU START? DO YOU HAVE ANY RELATIVES WORKING FOR OUR COMPANY? Yes No IF SO, GIVE NAME(S) CAN/WILL YOU TRAVEL IF THE JOB REQUIRES IT? YES NO COMMENTS DO YOU HAVE A DRIVER LICENCE? YES NO TYPE CLASS 1 CDL A CDL B HAVE YOU EVER BEEN CONVICTED OF A FELONY? YES NO IF YES, PLEASE EXPLAIN (A criminal offense will not necessarily disqualify you from employment, but each offense will be evaluated based upon its nature, when it occurred and the type of position sought with the company) CURRENT ADDRESS (Street, City, State, Zip Code) EDUCATION (circle years completed) Elementary High School Diploma GED Vocational/Technical Degree Y N College or University Degree Y N NAMES AND LOCATIONS OF ANY VOCATIONAL/TECHNICAL SCHOOLS, COLLEGES, OR UNIVERSITIES ATTENDED Graduate Degree Y N SKILLS (list any special skills or qualifications, including any machines you can operate) REFERENCES (Give name, address and phone number of three professional or work references) NAME PHONE RELATIONSHIP (Supervisor, Co-worker, etc.) We are an equal opportunity employer, dedicated to a policy of non-discrimination due to race, color, age, sex, religion, national origin, disability, veteran status, or any other basis prohibited by federal or state law. Rev. 02/8/13 Page 1 of 4

2 EMPLOYMENT RECORD CURRENT OR We are an equal opportunity employer, dedicated to a policy of non-discrimination due to race, color, age, sex, religion, national origin, disability, veteran status, or any other basis prohibited by federal or state law. Rev. 02/8/13 Page 2 of 4

3 APPLICANT ACKNOWLEDGEMENT AND CERTIFICATION DRUG FREE WORKPLACE NOTICE TO ALL APPLICANTS Sioux Falls Construction and its subsidiaries require drug and alcohol testing of all employees. Newly hired employees must complete a post offer drug and alcohol test prior to reporting to duty at their normal job site. In addition, all employees are subject to random drug and alcohol testing at any time. These tests are highly sophisticated and capable of detecting trace amounts of various drugs. If you test positive on your initial post-offer drug and alcohol test, you will face immediate dismissal. You will be eliminated from consideration for all employment for a minimum of six (6) months, or until you provide satisfactory proof of successful completion of an accepted drug and alcohol abuse treatment program. If subsequent random test results indicate the presence of drugs or alcohol in your body, in order to continue employment with the Company, you will be required to comply with the provisions of our drug and alcohol policy, including counseling with our Employee Assistance Provider (EAP) and completion of any recommended course of treatment. This company will not conduct confirmatory testing of Drug and Alcohol screening except as provided by law. However, you may arrange for the re-testing of any previously submitted specimens at your own expense. If re-testing indicates that the initial results were erroneous, the company will reimburse you for the cost of confirmatory testing and will reinstate your employment. My signature on this application form indicates that I understand and accept the Company s Drug Free Workplace policy requirements. ACKNOWLEDGEMENT AND CERTIFICATION STATEMENT I certify that this application was completed by me, and that all entries on it and information in it is accurate and complete to the best of my knowledge. The Company may investigate all statements contained in this application. If I am hired, I understand that any false or misleading information provided during the application or interview process will be grounds for immediate dismissal, regardle ss of when it is discovered. I authorize the Company to make a thorough investigation of my past employment, education and job-related activities and I release from all liability all persons, companies, and corporations providing such information, either in writing or orally. I indemnify this Company against any liability which might result from such investigation. I authorize the Company to supply my employment record, in its sole discretion, in whole or in part, to any prospective employer, government agency, or other party, with an interest that the Company deems appropriate. I understand that the information in this application will be used and prior employers will be contacted to conduct investigations as required by Sec of Department of Transportation regulations, if applicable. I understand that this application is not a contract of employment. If I am hired, my employment will be terminable-at-will, regardless of any representations made to the contrary. The Company and I will remain free to end our employment relationship at any time, for any or no reason. Any changes in this employment relationship must be made in writing. I understand that any offer of employment may be conditioned upon a health evaluation to determine whether I can perform the essential functions of the job. This health evaluation will be completed by a Company-selected doctor. In addition, I understand a drug or alcohol test is required. APPLICANT SIGNATURE DATE All applications should be submitted directly to Human Resources. To apply: Bring your application to: Journey Group 800 S 7 th Ave Sioux Falls SD Fax your application to: Scan and your application to: careers@journey construction.com Mail your application to: Journey Group PO Box 2728 Sioux Falls, SD We are an equal opportunity employer, dedicated to a policy of non-discrimination due to race, color, age, sex, religion, national origin, disability, veteran status, or any other basis prohibited by federal or state law. Rev. 02/8/13 Page 3 of 4

4 VOLUNTARY INVITATION TO SELF-IDENTIFY We are a company that values diversity and actively encourage women and minorities to apply. Refusal to provide this information will have no bearing on your application and will not subject you to any adverse treatment. If you choose to provide the requested information, your responses will remain confidential within the Human Resources Department. NAME (Please Print) LIST REQUISITION # OF ALL POSITION(S) APPLIED FOR GENDER Male Female RACE OR ETHNIC IDENTITY (PLEASE CHECK ALL THAT APPLY) Hispanic or Latino - A person of Cuban, Mexican, Puerto Rican, South or Central American, or other Spanish culture or origin regardless of race. White (not Hispanic or Latino) - A person having origins in any of the original peoples of Europe, the Middle East or North Africa. Black or African American (not Hispanic or Latino) - A person having origins in any of the black racial groups of Africa. Native Hawaiian or Pacific Islander (not Hispanic or Latino) - A person having origins in any of the peoples of Hawaii, Guam, Samoa or other Pacific Islands. Asian (not Hispanic or Latino) - A person having origins in any of the original peoples of the Far East, Southeast Asia, or the Indian Subcontinent, including, for example, Cambodia, China, India, Japan, Korea, Malaysia, Pakistan, the Philippine Islands, Thailand and Vietnam. American Indian or Alaskan Native (not Hispanic or Latino) - A person having origins in any of the original peoples of North or South America (including Central America) and who maintain tribal affiliation or community attachment. Two or More Races (not Hispanic or Latino) - All persons who identify with more than one of the above five races. I do not wish to Self-Identify APPLICANT SIGNATURE DATE We are an equal opportunity employer, dedicated to a policy of non-

5 Voluntary Self-Identification of Disability Why are you being asked to complete this form? Form CC-305 OMB Control Number Expires 1/31/2017 Page 1 of 2 Because we do business with the government, we must reach out to, hire, and provide equal opportunity to qualified people with disabilities. i To help us measure how well we are doing, we are asking you to tell us if you have a disability or if you ever had a disability. Completing this form is voluntary, but we hope that you will choose to fill it out. If you are applying for a job, any answer you give will be kept private and will not be used against you in any way. If you already work for us, your answer will not be used against you in any way. Because a person may become disabled at any time, we are required to ask all of our employees to update their information every five years. You may voluntarily self-identify as having a disability on this form without fear of any punishment because you did not identify as having a disability earlier. How do I know if I have a disability? You are considered to have a disability if you have a physical or mental impairment or medical condition that substantially limits a major life activity, or if you have a history or record of such an impairment or medical condition. Disabilities include, but are not limited to: Blindness Deafness Cancer Diabetes Epilepsy Autism Cerebral palsy HIV/AIDS Schizophrenia Muscular dystrophy Bipolar disorder Major depression Multiple sclerosis (MS) Missing limbs or partially missing limbs Post-traumatic stress disorder (PTSD) Obsessive compulsive disorder Impairments requiring the use of a wheelchair Intellectual disability (previously called mental retardation) Please check one of the boxes below: YES, I HAVE A DISABILITY (or previously had a disability) NO, I DON T HAVE A DISABILITY I DON T WISH TO ANSWER Your Name Today s Date

6 Voluntary Self-Identification of Disability Reasonable Accommodation Notice Form CC-305 OMB Control Number Expires 1/31/2017 Page 2 of 2 Federal law requires employers to provide reasonable accommodation to qualified individuals with disabilities. Please tell us if you require a reasonable accommodation to apply for a job or to perform your job. Examples of reasonable accommodation include making a change to the application process or work procedures, providing documents in an alternate format, using a sign language interpreter, or using specialized equipment. Section 503 of the Rehabilitation Act of 1973, as amended. For more information about this form or the equal employment obligations of Federal contractors, visit the U.S. Department of Labor s Office of Federal Contract Compliance Programs (OFCCP) website at PUBLIC BURDEN STATEMENT: According to the Paperwork Reduction Act of 1995 no persons are required to respond to a collection of information unless such collection displays a valid OMB control number. This survey should take about 5 minutes to complete.