Applications accepted for available positions ONLY

Transcription

1 APPLICATION SUBMITTAL INSTRUCTIONS All employment applications must be submitted to Garner s corporate office listed below to the attention of the HR department either in person or by fax, by or mail: Garner Environmental Services, Inc West 13 th Street Deer Park, Tx ATTN: HR Department (281) fax hr@garner-es.com Applications accepted for available positions ONLY ********APPLICANT PRE-SCREEN QUESTIONNAIRE********* The attached questionnaire must be completed to determine your eligibility for employment per Garner Environmental policies **************************************************** Please make sure the application is completed in full Please make sure items requiring initials are initialed, not checked Please make sure application is signed and dated Please DO NOT include copies of ID or certifications Incomplete applications will not be considered Rev

2 APPLICANT PRE-SCREEN QUESTIONNAIRE APPLICANT MUST MEET THE FOLLOWING CRITERIA SET BY OUR INSURANCE CARRIER IN ORDER TO DRIVE A COMPANY VEHICLE: (If applicant checks No to any of the following questions, applicant is not eligible for hire) Yes No Yes No Yes No Is Applicant a minimum Age of 21 years? Does Applicant have a valid driver s license (not suspended)? Does Applicant have an acceptable driving record? APPLICANT MUST SUCCESSFULLY PASS AN EXTENSIVE BACKGROUND CHECK PER OUR DISA BACKGROUND CRITERIA IN ORDER TO ENTER MOST PLANTS AND FACILITIES WE SERVICE: (If applicant checks Yes to any of the following questions, applicant is not eligible for hire) Yes No Does Applicant have a felony conviction or felony conviction disposition in the past 7 years? Yes No Yes No Does Applicant have a misdemeanor conviction or misdemeanor conviction disposition involving violence in the past 7 years? Does Applicant have a misdemeanor conviction or misdemeanor conviction disposition involving moral turpitude (dishonesty, fraud, theft, etc.) in the past 7 years? DISA scores each background according to the criteria provided by plant and facilities we service. A Yes answer to any of the above would prevent entry into most of these plants and facilities. APPLICANT IS REQUIRED TO SUCCESSFULLY PASS A PRE-EMPLOYMENT PHYSICAL AND DRUG SCREEN PER COMPANY POLICY: Applicant will have to successfully pass a pre-employment physical and drug screen which includes hair follicle testing. GARNER ENVIRONMENTAL POSITIONS REQUIRES A MINIMUM OF 50% TRAVEL (If applicant checks No to the following question, applicant is not eligible for hire) Yes No Is Applicant willing to travel if required? Applicant Name - Signature Date Applicant Name - Printed Garner Environmental Services, Inc. is an Equal Opportunity / Affirmative Action Employer Rev

3 EQUAL OPPORTUNITY / AFFIRMATIVE ACTION EMPLOYER APPLICATION FOR EMPLOYMENT Prospective employees will receive consideration without discrimination because of race, creed, color, sex, age, national origin, handicap or veteran status. Last Name First Name Middle Name Date Street Address City, State, Zip Home Telephone ( ) Cell Phone P E R S O N A L Have you ever applied for employment with us? Yes No If Yes: Month and Year Location_ Position Desired Apart from absence for religious observance, are you available for full-time work? Yes No If not, what hours can you work? _ ( ) Social Security # Pay Expected $ Will you work overtime if asked? Yes No Are you legally eligible for employment in the United States? Yes No When will you be available to begin work? Other special training or skills (languages, machine operations, etc.) Please list all training and certifications and name as it appears on driver license.. Please list driver license number: State: If CDL, type: _. Have you ever had a driver license with another number? Yes No If so, what number(s)? Have you ever had a driver license in another state? Yes No If so, list all states and number(s)?. E D U C A T I O N School Name and Location of School Course of Study Graduate College Business/Trade/Technical High School No. Of Years Completed Did You Graduate? Yes No Yes No Yes No Yes No Degree or Diploma Elementary Yes No Membership in Professional or Civic Organizations (Exclude those which disclose your race, color, religion or national origin) Note: Applications will only be considered for 30 days from date above. All questions must be answered completely or Applications will be not be considered

4 EQUAL OPPORTUNITY / AFFIRMATIVE ACTION EMPLOYER EMPLOYMENT HISTORY Please give accurate, complete full-time and part-time employment record as the info will be used to verify past employment. Start with your present or most recent employer. 1 Company Name Full Address including city, state and zip Name of Supervisor State Job Title and Describe Your Work Telephone ( ) Employed MM/DD/YYYY From To Weekly pay Start Last Reason for Leaving 2 Company Name Full Address including city, state and zip Name of Supervisor State Job Title and Describe Your Work Telephone ( ) Employed MM/DD/YYYY From To Weekly pay Start Last Reason for Leaving 3 Company Name Full Address including city, state and zip Name of Supervisor State Job Title and Describe Your Work Telephone ( ) Employed MM/DD/YYYY From To Weekly pay Start Last Reason for Leaving 4 Company Name Full Address including city, state and zip Name of Supervisor State Job Title and Describe Your Work Telephone ( ) Employed MM/DD/YYYY From To Weekly pay Start Last Reason for Leaving We may contact the employers listed above unless you state truthfully that you are still currently employed with said employer. Do Not Contact Current Employer listed below Reason MILITARY Did you serve in the U.S. Armed Forces? Yes No Describe any training received relevant to the position for which you are applying: If Yes In, what Branch? Note: Applications will only be considered for 30 days from date above. All questions must be answered completely or Applications will be not be considered

5 EQUAL OPPORTUNITY / AFFIRMATIVE ACTION EMPLOYER The below information requested is needed for a legally permissible reason, including, without limitation, national security considerations, a legitimate occupational qualification or business necessity. The Civil Rights Act of 1964 prohibits discrimination in employment because of race, color, religion, sex or national origin. Federal law also prohibits discrimination based on age, citizenship and disability. The laws of most States also prohibit some or all the above types of discrimination as well as some additional types as discrimination based upon ancestry, marital status and sexual preference. Please Read and INITIAL each section as you answer to ensure no question is missed. Provide dates you attended school: Elementary Number of dependents, including yourself From To will be requested if you are hired. High School College Are you a US Military veteran? From To From To Yes No Other (give name and dates) Are you available to work nights? Yes No Is your U.S. Residence legal? Yes No Are you available to be on-call? Yes No What was your previous address? How long at present address? years How long at previous address? years Have you ever been bonded? Yes No Are you over 18 years of age? If Yes, with what employers? Yes No Have you ever been convicted of a felony or a misdemeanor involving violence or moral turpitude (dishonesty, fraud, theft, etc)? Yes No If Yes, describe in full an application will not be considered if detailed information is not given. (A conviction will not automatically disqualify an applicant for a particular job. The type and seriousness of the crime, the frequency of violations, the applicant's age at the time of conviction, the date of conviction and the applicant s entire work and education and history will be considered.) State names of relatives and friends working for us. Please Read and INITIAL Each Paragraph Below (if there is any part of the following you do not understand, please ask the interviewer about it before signing). Please note: your application will not be considered if you fail to initial beside each Paragraph below. I understand that consideration for employment in this position is contingent upon the results of a reference and background check. I therefore authorize this company to investigate all statements made on my application for employment, including but not limited to requesting a criminal background check and to discuss the results of its investigations with those responsible for hiring. I further authorize the company to contact my former employer(s) and any listed references or other persons who can verify information, and give my consent for former employers(s) and other contacted persons to respond to questions pertaining to information on this application. Further, I release from liability such former employer(s) or other persons contacted by and providing information to the company. In the event I am hired, I authorize Garner Environmental Services, Inc. to request and obtain a background and/or criminal background checks on me during my employment, with or without notice. Note: Applications will only be considered for 30 days from date above. All questions must be answered completely or Applications will be not be considered

6 EQUAL OPPORTUNITY / AFFIRMATIVE ACTION EMPLOYER I hereby authorize Garner Environmental Services, Inc. to thoroughly investigate my references, work records, education and other matters related to my suitability for employment and, further, authorize my current and former employers to disclose to the company any and all letters, reports, and other information pertaining to my employment with them, without giving me prior notice of such disclosure. In addition, I hereby release Garner Environmental Services, Inc., my current and former employers, and all other persons, corporation, partnerships and associations from any and all claims, demands or liabilities arising out of or in any related to such investigation or disclosure. I understand that if offered employment, the offer may be contingent on my passing a pre-employment alcohol and drug screen and a pre-employment physical. By signing this application, I voluntarily agree to submit to a pre-employment alcohol/drug screen and pre-employment physical upon request. I understand that failure to pass the alcohol/drug screen and/or physical will result in withdrawal of the employment offer. If hired, I also agree to submit to alcohol or drug testing as a condition of employment. I agree that Garner Environmental Services, Inc. may conduct alcohol or drug screening at its discretion with or without notice. I also understand that refusal to immediately submit to an alcohol/drug screen upon notice to do so will be considered a voluntary resignation of employment and I will cooperate with Garner Environmental Services, Inc. in connection with my voluntary discharge. If hired, I also agree to submit to alcohol or drug testing if requested by a customer of Garner Environmental Services, Inc. I also understand that refusal to submit to an alcohol/drug screen requested by a customer of Garner Environmental Services, Inc. will be considered a voluntary resignation of my employment and I will cooperate with Garner Environmental Services, Inc. in connection with my voluntary discharge. I hereby understand and acknowledge that it is the policy of Garner Environmental Services, Inc. as well as companies and customers for which Garner Environmental Services, Inc. performs services: (1) to prohibit the use, possession, sale, and distribution of alcohol, illegal drugs, or other controlled substances on its premises; and, (2) to prohibit the presence on company property or customer property, including but not limited to offices, worksite or vehicles, of any employee, subcontractor, or agent of company who has such substances in his/her body for non-medical reasons. I understand and agree that entry onto company property or premises constitutes consent to an inspection of the employee, subcontractor, agent, including vehicles and personal effects when entering, while on, or upon leaving company property. I understand that any employee, subcontractor or agent who is found in violation of this policy may be subject to disciplinary action up to and including discharge. I further understand and acknowledge that my refusal to submit to a search and/or a blood and/or drug and/or alcohol test or screen upon request by either Garner Environmental Services, Inc. or any company or customer for which Garner Environmental Services, Inc. provides services will subject me to immediate termination. I further acknowledge that I am hereby notified that: companies for which Garner Environmental Services, Inc. performs services have adopted same or similar policies prohibiting drug and alcohol use and/or the presence of drug and/or alcohol in or on an employee or agent of company. Employees or agents, by virtue of their association with Garner Environmental Services, Inc., may be subject to random drug and alcohol testing administered at the request of a company for which services are performed. Employees who are administered a random drug test whether at the request of Garner Environmental Services, Inc. and/or a company for which services are performed and who test positively for the presence of alcohol and/or drugs will be subject to disciplinary action up to and including immediate discharge. I understand and agree that any future changes in my title, duties, compensation, working conditions, and/or Garner Environmental Services, Inc. benefits, policies and procedures will not alter our at-will employment agreement. I understand that if offered employment, I will, as a condition of employment, be required to submit proof of my identity and legal right to work in the United States on my first day of employment. Note: Applications will only be considered for 30 days from date above. All questions must be answered completely or Applications will be not be considered

7 EQUAL OPPORTUNITY / AFFIRMATIVE ACTION EMPLOYER If the position applied for requires driving in the course of work, I understand that I will be required to possess a current and valid driver s license and understand that I will be required to provide a copy of my official driving record and proof of insurance. I also understand that any offer of employment is contingent on my ability to be covered by Garner Environmental Services, Inc. auto insurance, if required for my position. I hereby authorize Garner Environmental Services, Inc to obtain information on my automobile driving history by requesting my driving record from the appropriate or any state department. I further understand and acknowledge that in the event I am hired, Garner Environmental Services, Inc. will obtain my driving record from the appropriate state agency from time to time in Garner Environmental Services, Inc discretion, and I hereby authorize Garner Environmental Services, Inc. to obtain my driving record in its discretion during my employment from time to time, without notice, if I am hired. I further agree to sign an authorization for prospective employer to obtain consumer report for employment purposes in the form attached hereto. I understand that my application for employment will not be considered unless I sign the attached authorization. I further agree that in the event I am hired, Garner Environmental Services, Inc. may obtain my consumer report and/or consumer credit report from an appropriate agency and/or credit agency from time to time in Garner Environmental Services, Inc.'s sole discretion, and I hereby authorize Garner Environmental Services, Inc. to obtain my consumer report and/or consumer credit report in its sole discretion during my employment from time to time, without notice, if I am hired. I understand that nothing contained in the application or conveyed to me during my interview, which may be granted, is intended to create an employment contract, implied or explicit, between Garner Environmental Services, Inc and me. In addition, I understand and agree that if I am employed, my employment relationship with Garner Environmental Services, Inc. is strictly voluntary and at our mutual will. I understand that if employed, my employment is for no definite period and may be terminated at any time, with or without prior notice, with or without cause or reason, at the option of either myself or Garner Environmental Services, Inc. and that no promises or representation contrary to the foregoing are binding on Garner Environmental Services, Inc. I hereby certify that I have not knowingly withheld any information that might adversely affect my chances for employment and that the answers given by me are true and correct to the best of my knowledge. I further certify that I, the undersigned applicant, have personally completed this application. I understand that any omission or misstatement on this application or on any documents used to secure employment shall be grounds for rejection of this application or for immediate discharge if I am employed, regardless of the time elapsed before discovery. My signature below certifies that I have read and understand this complete document, and agree to the terms and conditions outlined in this document. Applicants Signature Date Garner Environmental Services, Inc W. 13 th Street Deer Park, Texas Revised Note: Applications will only be considered for 30 days from date above. All questions must be answered completely or Applications will be not be considered

8 APPLICANT S DISCLOSURE AND ACKNOWLEDGMENT FORM In connection with and for the duration of my employment, if hired, I understand that Garner Environmental Services, Inc. (GESI) may obtain consumer reports and/or investigative consumer reports for employment purposes that relate to my credit, criminal, driving, employment, or education history. This information will, in whole or in part, be obtained from DISA, Inc. Background Screening Services (DISA), Northborough Drive, Suite 300, Houston, Texas 77067, telephone These reports may include information as to my general reputation, character, personal characteristics, work habits, job performance, and experience, along with reasons for termination of past employment from previous employers. I understand that GESI will be requesting this information from various federal, state, county and other agencies or institutions, which maintain public and non-public records concerning my past activities relating to my driving, credit, civil, education, and other experiences. I further understand that I have the right to request, in writing, the nature and scope of any investigative consumer report and a Summary of Consumer Rights as prescribed by Section 606 of the Fair Credit Reporting Act. I acknowledge that, if a job offer is made, that the above consumer reports and/or investigative consumer reports may be obtained. I will submit the applicable consent forms provided by GESI in order to obtain the above mentioned information. Applicant Name Printed Applicant Name Signature _ Date

9 INVITATION TO SELF-IDENTIFY FOR PURPOSES OF EEOC & AFFIRMATIVE ACTION REPORTING Due to participation in government contracts, Garner Env is subject to certain governmental recordkeeping and reporting requirements. In order to comply with these laws, the company invites employees to voluntarily self-identify their race/ethnicity and gender status. Submission of this information is voluntary and refusal to provide it will not subject you to any adverse treatment. The information obtained will be kept confidential and may only be used in accordance with the provisions of applicable laws, executive orders, and regulations, including those that require the information to be summarized and reported to the federal government. When reported, data will not identify any specific individual. Please Check One: Male Female Please Check One: 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 Hispanic or Latino: a person of Cuban, Mexican, Chicano, Puerto Rica, South or Central American or other Spanish culture or origin, regardless of race Native Hawaiian or Other Pacific Islander (not Hispanic or Latino): a person having origins in any of the original 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 Alaska Native (not Hispanic or Latino): a person having origins in any of the original peoples of North and South America, including South Central America, and who maintains tribal affiliation or community attachment Two or More Races (not Hispanic or Latino) Check here if you do not wish to participate Applicant Name (printed): Applicant Signature: Date:

10 Invitation to Self-Identify for Protected Veterans As an EEO/AA employer, GESI, Inc. is subject to the Vietnam Era Veterans Readjustment Assistance Act of 1974 (VEVRAA) which requires government contractors to take affirmative action to employ and advance veterans in employment. VEVRAA prohibits discrimination and requires affirmative action in all personnel practices regarding protected veterans. The statute covers disabled veterans, Armed Forces service medal veterans, recently separated veterans, and other veterans who served during a war, or in campaign or expedition for which a campaign badge has been authorized. Please check all that apply: _ Disabled Veteran _ Special Disabled Veteran _ Veteran of the Vietnam era _Other Protected Veteran _ Armed Forces Service Medal Veteran _ Other Veteran _ Not a Veteran _ I do not wish to participate Employee Name (printed): _ Date: Employee Signature: VETERAN CATEGORY DEFINITIONS: Disabled Veteran: a veteran of the U.S. military, ground, naval or air service who is entitled to compensation (or who but for the receipt of military retired pay would be entitled to compensation) under laws administered by the Secretary of Veterans Affairs, or a person who was discharged or released from active duty because of a service-connected disability. Special Disabled Veteran: a veteran of the U.S. military, ground, naval or air service who is entitled to compensation (or who but for the receipt of military retired pay would be entitled to compensation) under laws administered by the Department of Veterans' Affairs for a disability (A) rated at 30 percent or more, or (B) rated at 10 or 20 percent in the case of a veteran who has been determined under Section 38 U.S.C to have a serious employment handicap or (ii) a person who was discharged or released from active duty because of a service connected disability. Veteran of the Vietnam era: a person who: served on active duty in the U.S. military, ground, naval or air service for a period of more than 180 days, and who was discharged or released there from with other than a dishonorable discharge, if any part of such active duty was performed: (A) in the Republic of Vietnam between February 28, 1961, and May 7, 1975; or (B) between August 5, 1964, and May 7, 1975, in all other cases; or was discharged or released from active duty in the U.S. military, ground, naval or air service for a service connected disability if any part of such active duty was performed (A) in the Republic of Vietnam between February 28, 1961, and May 7, 1975; or (B) between August 5, 1964, and May 7, 1975, in any other location. Page 1 of 2

11 VETERAN CATEGORY DEFINITIONS: - continued Other Protected Veteran: veterans who served on active duty in the U.S. military, ground, naval or air service during a war or in a campaign or expedition for which a campaign badge has been authorized. For those with Internet access, the information required to make this determination is available at Armed Forces Service Medal Veteran: a veteran who, while serving on active duty in the U.S. military, ground, naval or air service, participated in a United States military operation for which an Armed Forces service medal was awarded pursuant to Executive Order (61 Fed. Reg. 1209) at Other Veteran: a veteran of the U.S. military, ground, naval or air service that is not included in one of the categories listed above. You may inform us of your desire to benefit under the program at this time and/or at any time in the future. Submission of this information is voluntary and refusal to provide it will not subject you to any adverse treatment. The information provided will be used only in ways that are not inconsistent with the Vietnam Era Veterans' Readjustment Assistance Act of 1974, as amended. The information you submit will be kept confidential, except that (1) supervisors and managers may be informed regarding restrictions on the work or duties of disabled veterans, and regarding necessary accommodations; (2) first aid and safety personnel may be informed, when and to the extent appropriate, if you have a condition that might require emergency treatment; and (3) Government officials engaged in enforcing laws administered by OFCCP, or enforcing the Americans with Disabilities Act, as amended, may be informed. It is the policy of Garner Environmental Services, Inc. [GESI] not to discriminate against any employee or applicant for employment because he or she is a protected veteran. A written copy of this Affirmative Action Program is available for inspection by any employee or applicant for employment, during normal business hours, in the Personnel Department. Interested persons should contact the Personnel Manager at for assistance. If you are a disabled veteran it would assist us if you tell us about (1) any special methods, skills, and procedures that qualify you for positions that you might not otherwise be able to do because of your disability so that you will be considered for any positions of that kind, and (2) any accommodations that we could make that would enable you to perform the job, including special equipment, changes in the physical layout of the job, elimination of certain duties relating to the job, provision of personal assistance services or other accommodations. This information will assist us in placing you in an appropriate position and in making accommodations for your disability. Page 2 of 2

12 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

13 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. i 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.