Application for Employment

Application for Employment
Essential Functions for shop and field employees

Please read carefully as this information will be used to answer another question on another page.
The position with our company you have applied for/or will be applying for requires you to be able to perform the following duties on a regular, daily basis without limitations:
- Operate Equipment
- Be able to lift 100 pounds
- Be able to climb in and on equipment
- Be able to enter and exit manholes
- Be able to climb a ladder
- Be able to stand for long periods of time
- Be able to walk the jobsite for extended distances and on uneven surfaces
- Be able to move quickly
- Be able to use handtools, shovels, sledge hammers, saws, drills, and grinders
- Be able to stoop and bend over
- Be able to withstand working in various temperatures and weather environments

Application for Employment

Equal access to programs, services and employment is available to all persons. Those applicants requiring reasonable accommodation to the application and/or interview process should notify a representative of the Human Resources Department.
Contact Information
Date of application

MonthDayYear
Date
What position are you applying for?
Put what position you would like to apply for here
Name*

First NameMiddle NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*
Please enter a valid phone number.
Email*
example@example.com

Application Questions
Referral Source
Pick where you heard about us from!
When is the best time to call you?
Give a time and be sure to include AM or PM for clarity
May we contact you at work?
If yes, number and best time to call
Include your work number and best time to call
If you are under 18 and it is required, can you furnish a work permit? Skip this if you are over 18.
If you answered no to this question can you explain why not?
Explain why you can't provide a work permit
Have you submitted an application here before?
If you have submitted before can you give dates and position applied for?
Have you ever been employed here before?
If you have submitted before can you give dates and your previous position?
Is this application a request for reemployment following an extended military leave of absence?
If the answer was yes to the previous question then additional information may be requested
Nothing goes here!
Are you legally eligible for employment in this country?
What date are you available to start working?

MonthDayYear
Pick the date that you are available to start work
What is your desired salary range or hourly rate of pay?
What is the type of employment that you desire?
Will you relocate if the job requires it?
Will you travel if the job requires it?
If they have been explained to you, are you able to meet the attendance requirements of the position?
Will you work overtime if required?
If no, please explain why not
Are you able to perform the "essential functions" of the job for which you are applying (with or without reasonable accommodations?)
This question is not designed to elicit information about an applicant's disability. Please do not provide information about the existence of a disability, particular accommodation, or whether accommodation is necessary. These issues may be addressed at a later stage to the extent permitted by law.
Drivers license number
Drivers license number is required if the job you are applying for requires driving
State license was issued?
Have you ever been bonded?
Answering yes to the following question does not constitute an automatic bar to employment. Factors such as date of the offense, seriousness and nature of the violation, rehabilitation and position applied for will be taken into account.
Have you ever pleaded "guilty" or "no contest" to or been convicted of a crime?
If yes please provide dates and details
Have you entered into an agreement with any former employer or other party (such as a noncompetition agreement) that might, in any way, restrict your ability to work for our company?
If yes please explain

Employment History
Employer #1 Information
Starting Compensation for Employer #1
Put your starting wages here
The drop down on the left is used to select hourly or salary for clarity
Final Compensation for Employer #1
Put your final wages here
The drop down on the left is used to select hourly or salary for clarity
Employer #2 information
Starting Compensation for Employer #2
Put your starting wages here
The drop down on the left is used to select hourly or salary for clarity
Final Compensation for Employer #2
Put your final wages here
The drop down on the left is used to select hourly or salary for clarity
Employer #3 information
Starting Compensation for Employer #3
Put your starting wages here
The drop down on the left is used to select hourly or salary for clarity
Final Compensation for Employer #3
Put your final wages here
The drop down on the left is used to select hourly or salary for clarity
Employer #4 information
Starting Compensation for Employer #4
Put your starting wages here
The drop down on the left is used to select hourly or salary for clarity
Put your final wages here
The drop down on the left is used to select hourly or salary for clarity
Final Compensation for Employer #4

Employment History Continued
If not addressed on previous page, have you ever been fired or asked to resign from a job? If yes please explain.
Explain any gaps in your employment, other than those due to personal illness, injury or disability.

Skills and Qualifications
Summarize any special training, skills, licenses and/or certificates that may assist you in performing the position for which you are applying:
Computer skills (check all that apply)

Word processingSpreadsheetPresentationEmailInternetOther
Describe your skills and years of use

Educational Background

Start with your most recent school attended, provide the following information below
Educational Information (hit the add row button to add more as needed)

References

List names and telephone numbers of three business/work references who are NOT related to you and are NOT previous supervisors. If not applicable, list three school or personal references who are NOT related to you
References (hit the add row button to add more as needed)

Social Security Number

We will use this information for employment purposes and make reasonable efforts to safeguard your privacy
Enter here

Related information

to what job related orginzations (professional, trade, etc.) do you belong?
Related information (click add row as needed)
List special accomplishments, publications, awards, etc.
In your current or previous job have you ever written instructions or directions to be followed by employees or customers?
If yes please explain
Is there any other job-related information you want us to know about you?

Applicant Statement
I certify that all information I have provided in order to apply for and secure work with this employer is true, complete, and correct.

I expressly authorize, without reservation, the employer, its representatives, employees or agents to contact and obtain information from all references (personal and professional), employers, public agencies, licensing authorities and educational institutions and to otherwise verify the accuracy of all information provided by me in this application, resume or job interview. I hereby waive any and all rights and claims I may have regarding the employer, its agents, employees or representatives, for seeking, gathering and using truthful and non-defamatory information, in a lawful manner, in the employment process and all other persons, corporations or organizations for furnishing such information about me.

I understand that this employer does not unlawfully discriminate in employment and no question on this application is used for the purpose of limiting or eliminating any applicant from consideration for employment on any basis prohibited by applicable local, state or federal law.

I understand that this application remains current for only 30 days. At the conclusion of that time, if I have not heard from the employer and still wish to be considered for employment, it will be necessary for me to reapply and fill out a new application.

If I am hired, I understand that I am free to resign at any time, with or without cause and with or without prior notice, and the employer reserves the same right to terminate my employment at any time, with or without cause and with or without prior notice, except as may be required by law. This application does not constitute an agreement or contract for employment for any specified period or definite duration. I understand that no supervisor or representative or the employer is authorized to make any assurances to the contrary and that no implied oral or written agreements contrary to the foregoing express language are valid unless they are in writing and signed by the employer's president.

I also understand that if I am hired, I will be required to provide proof of identity and legal authorization to work in the United States and that federal immigration laws require me to complete an I-9 Form in this regard.

This Company does not tolerate unlawful discrimination in its employment practices. No question on this application is used for the purpose of limiting or excluding an applicant from consideration for employment on the basis of his or her sex, race, color, religion, national origin, genetic information, citizenship, age, disability, or any other protected status under applicable federal, state, or local law. This Company likewise does not tolerate harassment based on sex, race, color, religion, national origin, citizenship, genetic information, age, disability, or any other protected status. Examples of prohibited harassment include, but are not limited to, unwelcome physical contact, offensive gestures, unwelcome comments, jokes, epithets, threats, insults, name-calling, negative stereotyping, possession or display of derogatory pictures or other graphic materials, and any other words or conduct that demean, stigmatize, intimidate, or single out a person because of his/her membership in a protected category. Harassment of our employees is strictly prohibited, whether it is commited by a manager, coworker, subordinate, or non-employee (such as a vendor or customer). The Company takes all complaints of harassment seriously and all complaints will be investigated promptly and thoroughly.

I understand that any information provided by me that is found to be false, incomplete or misrepresented in any respect, will be sufficient cause to (i) eliminate me from further consideration for employment, or (ii) may result in my immediate discharge from the emoplyer's service, whenever it is discovered.

DO NOT SIGN UNTIL YOU HAVE READ THE ABOVE APPLICANT STATEMENT.

I certify that I have read, fully understand and accept all terms of the foregoing Applicant Statement.
Signature*

Clear
Date

MonthDayYear
Date

Additional Information

This section will have additional information that needs to be read for better understanding of how the application process works
This organization Participates in E-Verify.

This employer will provide the Social Security Administration (SSA) and, if necessary, the Department of Homeland Security (DHS), with information from each new employee's Form I-9 to confirm work authorization.

IMPORTANT: If the government cannot confirm that you are authorized to work, this employer is required to give you written instructions and an opportunity to contact DHS and/or the SSA before taking adverse action against you, including termininating your employment.

Employers may not use E-Verify to pre-screen job applicants and may not limit or influence the choice of documents you presnet for use on the form I-9.

To determine whether Form I-9 documentation is valid, this employer uses E-verify's photo matching tool to match the photograph appearing on some permanent resident cards, employment authorization cards, and U.S. passports with the official U.S. government photograph. E-Verify also checks data from driver's licenses and identification cards issued by some states.

If you believe that your employer has violated its responsibilities under this program or has discriminated against you during the employment eligibility verification process based upon your national origin or citzenship status, please call the office of Special Counsel at 800-255-7688, 800-237-2515 (TDD) OR at www.justice.gov/crt/osc
Employment verification acknowledgement and authorization

I UNDERSTAND THAT IF I AM EMPLOYED BY G.P.'S ENTERPRISES INC., THE COMPANY WILL VERIFY MY NAME AND SOCIAL SECURITY NUMBER THROUGH THE DEPARTMENT OF HOMELAND SECURITYS E-VERIFY ELECTRONIC VERIFICATION PROGRAM (FORMERLY KNOWN AS THE BASIC PILOT PROGRAM).

I ALSO UNDERSTAND THAT IF I AM A NON-CITIZEN, MY PHOTOGRAPH WILL BE VERIFIED WITH THE DEPARTMENT OF HOMELAND SECURITY. IF I AM EMPLOYED AND THE COMPANY LATER FINDS THAT I AM NOT AUTHORIZED TO WORK IN THE UNITED STATES, I UNDERSTAND THAT MY EMPLOYMENT WILL BE TERMINATED IMMEDIATELY AND THE COST OF MY DRUG SCREEN WILL BE DEDUCTED FROM MY PAYCHECK. I ALSO AGREE THAT IF I AM FOUND TO BE UNAUTHORIZED TO WORK IN THE UNITED STATES, $100 WILL BE WITHHELD FROM MY FINAL PAYCHECK TO COVER THE COST OF ORIENTATION AND RELATED PERSONNEL MATERIALS.
The information above is correct to your absolute knowledge and you have read and understood everything through the application process. Please sign here and continue to the end.*

Clear

Voluntary Affirmative Action and Veteran Status Data

Please note: Completion of this form is voluntary
We consider all applicants for positions without regard to race, color, religion, sex, national origin, citizenship, age, mental or physical disabilities, veterans, or any other similarly protected status. We also comply with all applicable laws governing employment practices and do not discriminate on the basis or any unlawful criteria.

To comply with requirements regarding government recordkeeping, reporting, and other legal obligations that may apply, we request that you complete this form. Providing this information is STRICTLY VOLUNTARY. Not providing it will not subject you to any negative personnel decision or action. Your cooperation is appreciated.

To be completed by applicant on a voluntary basis. Not for interviewing purposes. File seperately from application.

APPLICANT: Only complete this section if you have received an offer of employment.

As a Government contractor subject to VEVRAA, we are required to submit a report to the United States Department of Labor each year identifying the number of our employees belonging to each specified "protected veteran" category. If you believe you belong to any of the categories of protected veterans listed above, please indicate by checking the appropriate box.
I belong to the following classifications of protected veterans (choose all that apply):

Disabled VeteranRecently Separated VeteranActive-Duty wartime or campaign-badge veteranArmed forces service medal veteranI am a protected veteran, but I choose not to self-identify the classifications to which I belongI am not a protected Veteran
If you are a disabled veteran it would assist us if you tell us whether there are accommodations we could make that would enable you to perform the essential functions of the job, including special equipment, changes in the physical layout of the job, changes in the way the job is customarily performed, provision of personal assistance services or other accommodations. This information will assist us in making reasonable accommodations for your disability.

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 (i) supervisors and managers may be informed regarding restrictions on the word or duties of disabled veterans, and regarding necessary accommodations; (ii) 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 (iii) government officials engaged in enforcing laws administered by the Office of Federal Contract Complicance Programs, or enforcing the Americans with Disabilities Act, may be informed.
Signature

Clear
Date

MonthDayYear
Date
Should be Empty:

Application for Employment

Essential Functions for shop and field employees

Application for Employment

Contact Information

Application Questions

Employment History

Employment History Continued

Skills and Qualifications

Educational Background

References

Social Security Number

Related information

Applicant Statement

Additional Information

Voluntary Affirmative Action and Veteran Status Data

Applicant Information

Veteran Status Information: