TEC Application Rev 042916CDL EMPLOYMENT APPLICATION-San Francisco, CA PLEASE PRINT RESPONSES CLEARLY Last Name First Name Middle Initial Today s Date Present Street (Do not list P.O. Box) City State County Zip Code Home Phone No. PERSONAL INFORMATION Email and Location Applying For (Please specify Requisition #) Desired Rate of Pay $ per Req #: Desired Status Full Time Part Time Referred by: (Please check applicable box and specify if other source Staffing agency, please specify Online Job Board/Internet Site, please specify TEC Equipment Employee, please specify Desired Shift Day Shift Night Shift Cell Phone No. Are you legally authorized to work in the United States? Proof of legal authority to work in the United States will be required upon employment Yes No Available Start Date School, please specify Newspaper, please specify Other, please specify Are you at least 18 years of age? Yes No EMPLOYMENT HISTORY Do not use see resume in lieu of completing application form. Please complete all sections thoroughly. Start with most recent or present employer. Include part time and self-employment. Explain periods of non-employment below. 1 Employer Employed Earnings Other Compensation From To Beginning Ending Your responsibilities Job Title Name of Supervisor Reason for leaving Title of Supervisor May we contact this employer? Yes No Telephone No. 2 Employer Employed Earnings Other Compensation From To Beginning Ending Your responsibilities Job Title Name of Supervisor Reason for leaving Title of Supervisor May we contact this employer? Yes No Telephone No. 3 Employer Employed Earnings Other Compensation From To Beginning Ending Your responsibilities Job Title Name of Supervisor Title of Supervisor Please explain periods of non-employment Reason for leaving May we contact this employer? Yes No Telephone No. Have you previously been employed by any TEC Equipment company? Yes No If yes, which location? (s) held Under what name? From To Reason for leaving?
Name and of School Major or Type of Coursework Degree/Certificate TEC Application Rev 042916CDL Number of Did You Years Graduate? Completed High School EDUCATION Business/Technical College/University Graduate/Professional Other [Special CDL courses or training (if applicable), Seminars, Professional Education, Certifications, Correspondence Courses]: All persons shall have equal employment opportunities with TEC Equipment, Inc., and its subsidiaries (collectively, TEC Equipment ), regardless of race, color, creed, religion, national origin, ancestry, sex, gender identity, marital status, sexual orientation, disabil ity, veteran status, age and any other legally protected class. Employment shall be based solely on TEC Equipment s need and the individual s qualifications. I certify that I have completed this application and the statements I have made in this application are true and complete. I authorize investigation of all statements contained in this application which TEC Equipment, Inc., and/or its affiliates may deem relevant to my employment and authorize my previous employers or other persons having information concerning my records or me to report such information to TEC Equipment, Inc., and/or its affiliates. I hereby release TEC Equipment, Inc., and/or its affiliates, my former employer or other persons who may prov ide information from any liability as a result of providing such information. I understand and agree that if it is subsequently discovered that the information is untrue or that I have failed to disclose a material fact, any offer of employment made to me by TEC Equipment, Inc., and/or its affiliates may be immediately withdrawn or if I am already employ ed by TEC Equipment, Inc., and/or its affiliates, I may be subject to immediate dismissal at TEC Equipment s option in its sole and absolute discretion. I n such event, the withdrawal of any offer of employment made to me or the termination of employment shall be without any obliga tion or liability to me by TEC Equipment, Inc., and/or its affiliates, other than for wages at the rate agreed upon for work I have actually perfo rmed for TEC Equipment, Inc., and/or its affiliates. If I become employed, in consideration of my employment, I understand that I must comply with the rules, regulations, policies and procedures of TEC Equipment, Inc., and/or its affiliates. I am aware of and understand the physical requirements of the job and certify th at I can and will perform these requirements in a safe manner, with or without accommodation. In accordance with the Immigration and Control Act of 1986, TEC Equipment, Inc., and/or its affiliates will only hire United States citizens and aliens lawfully authorized to work in the United States. I understand that I will be required to complete the designated employment eligibility verification I-9 Form as a condition of employment. I understand that I may be required to undergo drug testing and/or a background check and that my employment is contingent upon these results. I will be advised if drug testing and/or a background check is required and complete the necessary authorizations. I understand that I am not obligated to disclose sealed or expunged records of conviction or arrest, and TEC Equipment, I nc., and/or its affiliates may not ask me if I have had such records sealed or expunged. I understand and agree that if I am employed by TEC Equipment, Inc., and/or its affiliates as a result of this application, my employment will be at at-will, which I understand means that I will not be employed for any definite period of time and that my employment may be terminated at any time. At-will employment may only be modified by written agreement signed by TEC Equipment s President. Signature: Date: COMPLETE THE FOLLOWING PORTION OF THE APPLICATION IF YOU ARE APPLYING FOR A POSITION WHERE YOU WILL OPERATE A MOTOR VEHICLE WEIGHING 26,001 POUNDS OR MORE. Do you have a valid Commercial Driver s License? Yes No License # Issuing State Exp. Date List states in which you have held a driver s license in the past 5 years: Are you 21 or older? Yes No At any of your previous employers for the last three years, did you operate a motor vehicle weighing 26,000 pounds or more? Yes No Complete the following page. If no commercial driving experience in the last three years, write none in Box 1.
1 2 TEC Application Rev 042916CDL 3 4 Initial here to indicate that you have included your entire job history for the last three years where you drove a vehicle weighing more than 26,001 pounds. Submit additional pages if needed. Have you ever been denied a license, permit, or privilege to operate a motor vehicle? Have you ever had any license, permit, or driving privilege suspended or revoked? YES NO YES NO In the past two years, have you tested positive, or refused to test, on a pre-employment drug or alcohol test administered by an employer where you applied for a safety sensitive position? YES NO VIOLATION AND RECORD REVIEW CERTIFICATION OF VIOLATION(S) I certify that the following is a true and complete list of all traffic violations (including revocation, suspension, or withdrawal of an operator's license, but not parking violations) for which I have been convicted or forfeited bond or collateral during the past 12 month s. (If none, write "none" on the first line.) 1) Date: 2) Date: Offense: Location: Type of Vehicle Operated: Offense: Location: Type of Vehicle Operated: 3) Date: 4) Date: Offense: Offense: Location: Location: Type of Vehicle Operated: Type of Vehicle Operated: If no violations are listed above, I certify that I have not been convicted or forfeited bond or collateral on account of any violation required to be listed during the past 12 months. This information is collected in accordance with Section 391.27 of the Motor Carrier Safety Regulations. I certify that I have completed this entire application and the statements I have made in this application are true and complet e. I authorize TEC Equipment to request a copy of my Motor Vehicle report as needed for pre-employment or employment purposes. This authorization remains in effect until I revoke it in writing. (Driver's Signature) (Date)
PRE-EMPLOYMENT/NEW EMPLOYEE EO 11246 and VIETNAM ERA VETERANS READJUSTMENT ASSISTANCE ACT (VEVRAA) INVITATION TO SELF-IDENTIFY TEC Equipment is a government contractor subject to Executive Order 11246 and the Vietnam Era Veterans Readjustment Assistance Act (VEVRAA), which requires affirmative action to employ and advance in employment qualified individuals without regard to race, color, national origin, religion, veteran status, sex, sexual orientation, or gender identity. We are compiling information to assist us in complying with our Affirmative Action Program goals, and are requesting you to complete this survey. Submission of this information is completely voluntary. Information provided will be kept confidential and used only in ways consistent with Executive Order 11246, VEVRAA, and government reporting requirements. Refusal to provide information will not subject you to any adverse employment decision. SECTION A Name Applied For: City State Zip SECTION B MARK ONE OF THE FOLLOWING CATEGORIES FOR GENDER: Male Female I do not wish to identify MARK ONE OF THE FOLLOWING CATEGORIES FOR ETHNICITY/RACE: Hispanic or Latino White (Only) American Indian or Alaska Native (Only) Native Hawaiian or other Pacific Islander (Only) Two or More Races (Non-Hispanic) Asian (Only) Black or African American (Only) I do not wish to identify If you choose not to self-identify your race/ethnicity at this time, the federal government requires this employer to determine this information by visual survey and/or other available information. MARK ONE OF THE FOLLOWING CATEGORIES FOR VETERAN STATUS: I am a Protected Veteran I am not a Protected Veteran I do not wish to identify You are a "protected veteran" under VEVRAA if you belong to one of the veterans categories described below: 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. Active Duty Wartime or Campaign Badge Veteran Any veteran during the three-year period beginning on the date of such veteran's discharge or release from active duty in the U.S. military, ground, naval, or air service. Recently Separated Veteran A veteran 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 under the laws administered by the Department of Defense. 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 12985.
Voluntary Self-Identification of Disability Why are you being asked to complete this form? Form CC-305 OMB Control Number 1250-0005 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
Voluntary Self-Identification of Disability Reasonable Accommodation Notice Form CC-305 OMB Control Number 1250-0005 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 www.dol.gov/ofccp. 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.