APPLICATION FOR EMPLOYMENT
UNITED SPRINKLER COMPANY,
INC.
United Sprinkler Company
is an equal opportunity employer and does not discriminate against otherwise
qualified applicants on the basis of race, color, creed, religion, ancestry,
age, sex, marital status, national origin, disability or handicap, or veteran
status.
PERSONAL:
Name: ______________________________________ Date ___________
(Last) (First) (Middle)
Address: ________________________________________________________
(number &
street) (City) (State) (Zip)
Phone Number: _________________ Social Security #: _________________
Position Sought:
____________________ Full Time
____ Part Time
____
Date Available: _______________ Salary Desired: _______________
Are you over 18 years
old? Yes ____ No ____
Are you legally eligible for
employment in the
If offered employment, you
will be required to provide documentation, per the attached list of acceptable
documents (detach for your records), to verify eligibility.
Have you ever worked for
this company before? Yes ____ No ____
If yes, when? _________________________
Do you have any relative or
friends that work for the company? Yes ___ No ___
If yes, who and where do
they work?
_________________________________
EDUCATION: Please indicate education or training which you
believe qualifies you for the position you are seeking.
High School:
________________________________________________________
(Name of School) (City,
State)
No. of years completed (circle one) 1
2 3 4
Diploma: Yes ____ No ____ G.E.D.:
Yes ____ No ____
College and/or Vocational School:
________________________________________________________________
(Name of School) (City, State)
No. of years completed (circle
one) 1
2 3 4
Major
_________________________
Degree(s) Earned __________________
Other Training or Degrees:
________________________________________________________________
(Name of School)
(City, State)
Course ________________ Degree or
Certificate Earned __________________
SKILLS:
Data Entry:
Excel ____ Lotus 1,2,3 ____ Typewriter
____ wpm
Other ____
Word Processing: WordPerfect ____ MS Word ____ Other
____
Other Skills:
______________________________________________________
RECORD OF CONVICTION:
During the last ten years,
have you even been convicted of a crime other than a minor traffic
offense? Yes ____ No ____
If yes, explain:_____________________________________________________
________________________________________________________________
(A conviction will not
necessarily automatically disqualify you for employment. Rather, such factors as age and date of
conviction, seriousness and nature of the crime, and rehabilitation will be
considered.)
EMPLOYMENT:
List last employer first,
including U.S. Military Service.
Are you presently employed? Yes ____ No ____
If yes, may we contact your
present employer? Yes ____ No ____
If any employment was under
a different name, indicate name _______________
________________________________________________________________
Employer: ____________________________________
Address:
________________________________________________________
Telephone number: _________________ Position:
___________________
Dates of Employment: From ________ To
________
Mo/Yr Mo/Yr
Salary: ________________ Supervisor:
___________________________
Department: ______________________________
Duties:
__________________________________________________________
FT ____ PT ____ No. of Hours ________
Reason for Leaving: _______________________________________________
Employer: ____________________________________
Address:
________________________________________________________
Telephone number: _________________ Position:
___________________
Dates of Employment: From ________ To
________
Mo/Yr Mo/Yr
Salary: ________________ Supervisor:
___________________________
Department: ______________________________
Duties:
__________________________________________________________
FT ____ PT ____ No. of Hours ________
Reason for Leaving:
_______________________________________________
Employer: ____________________________________
Address:
________________________________________________________
Telephone number: _________________ Position: ___________________
Dates of Employment: From ________ To
________
Mo/Yr Mo/Yr
Salary: ________________ Supervisor:
___________________________
Department: ______________________________
Duties: __________________________________________________________
FT ____ PT ____ No. of Hours ________
Reason for Leaving:
_______________________________________________
Employer: ____________________________________
Address:
________________________________________________________
Telephone number: _________________ Position:
___________________
Dates of Employment: From ________ To
________
Mo/Yr Mo/Yr
Salary: ________________ Supervisor:
___________________________
Department: ______________________________
Duties:
__________________________________________________________
FT ____ PT ____ No. of Hours ________
Reason for Leaving:
_______________________________________________
If you wish to describe
additional work experience, attach the above information for
each position on a separate piece of paper.
Explain any gaps in work
history:
_____________________________________
________________________________________________________________
Have you ever been
discharged or asked to resign from a job?
Yes ___ No ___
If yes, explain:
________________________________________________________________________________________________________________________________
REFERENCES:
PROFESSIONAL PERSONAL
Name: _____________________ Name:
____________________
Address: ___________________ Address: ___________________
___________________
___________________
Phone: (______) _____________ Phone: (______) _____________
Name: _____________________ Name: _____________________
Address: ___________________ Address: ____________________
___________________ ____________________
Phone: (______) ____________ Phone: (______)
_____________
APPLICANT’S
CERTIFICATION AND AGREEMENT
As a
condition of employment, I understand that the company requires the successful
completion of a urinalysis for drug testing purposes and I hereby agree and
consent to this test. Though a negative
drug test result must be received before a final offer of employment is
considered, it does not guarantee that a final offer of employment will be
made.
I hereby
certify that the facts set forth in the above employment application are true
and complete to the best of my knowledge.
I
understand that, if employed, falsified statements of any kind or omissions of
facts called for on this application shall be considered sufficient basis for
dismissal.
I
understand that in connection with my application for employment or employment
with United Sprinkler, consumer reports or investigative consumer reports,
which may contain public record information, may be requested or made on me,
including my creditworthiness or similar characteristics, employment and
education verifications, social security verification, criminal (*see end of
paragraph) and civil history, personal interviews, DMV records, any other
public records and any other information bearing on my credit standing, credit
capacity, character, general reputation, personal characteristics or mode of
living, and trustworthiness. These
reports will/may include both experience and performance along with reasons for
termination of past employment.
* If a
criminal history record is needed you can request this information, at your
expense, and bring it to us or we can request it, at our expense, for you. If we request it for you, the applicant or
the employee, will need to come in to complete an
additional form. This form authorizes
the applicable agency to directly release this information to United
Sprinkler. You must give your consent in
writing, under oath and your signature must be notarized. We have a Notary Public on staff that you are
welcome to use in completing this form.
I hereby
authorize and consent to United Sprinkler’s procurement of consumer and/or
investigative consumer reports and the verification of same for use in making
employment decisions. I further
authorize ongoing procurement of the above mentioned reports at any time during
my employment with United Sprinkler.
I
understand that, pursuant to the federal Fair Credit Reporting Act, United
Sprinkler will notify me if it uses such a report in making an adverse decision
regarding my fitness for employment with the Company. I further understand that if such report is
used to make an adverse employment decision, United Sprinkler will provide me a
copy of the Summary of Rights under FCRA along with the name, address, and
telephone number of the consumer reporting agency that furnished the report,
along with a statement that the consumer reporting agency did not make the
decision to take the adverse action and is unable to provide me with the specific
reasons why the adverse action was taken.
I further understand that I have the right to obtain a free copy of my
consumer report from the consumer reporting agency that provided the report to
United Sprinkler, so long as my request is made within 60 days of the Company’s
notification that an adverse employment decision has been made. I further understand that I have the right to
dispute the accuracy or completeness of any information contained in the
consumer report directly with the consumer reporting agency.
I hereby
release the consumer reporting agency, United Sprinkler, and any and all
persons, business entities and governmental agencies, whether public or
private, from any and all liability, claims and/or demands, of whatever kind,
to me, my heirs, or others making such claim or demand on my behalf, for
procuring, selling, providing, brokering, verifying the accuracy of, and/or
assisting with the compilation or preparation of the consumer report and/or
investigative consumer report hereby authorized.
I
understand that should an employment offer be extended to me and accepted, that
I will fully adhere to the policies, rules and regulations of employment of the
Employer. However, I further understand
that neither the policies, rules, regulations of employment nor anything said
during the interview process shall be deemed to constitute the terms of an
implied employment contract. I
understand that any employment offered is for an indefinite duration and at
will and that either I or the Employer may terminate my employment at any time
with or without notice or cause.
Name As It Appears on
Drivers License: ________________________________
Drivers License Number:
Signature of Applicant: _______________________________________
Date: _______________________