BW Electric Employment Application

B.W. Electric, Inc. Employment Application
BW Electric, Inc. Employment Application

Programs, services and employment are available equally to everyone. Please inform us if you require reasonable accommodation for the application or interview.
Position Applied For*
How were you referred to us?*

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Date*

MonthDayYear
Date

EDUCATION:
High School
High School
Address
Number of Years Completed
Did you Graduate?

YesNo
Degree
Major
GPA
Class Rank
College/University
College/University
Address
Number of Years Completed
Did you Graduate?

YesNo
Degree
Major
GPA
Class Rank
Other
Other
Address
of Years Completed
Did you Graduate?

YesNo
Degree

PROFESSIONAL LICENSE, CERTIFICATIONS OR MEMBERSHIP:
Type of Licenses Held
Type of Certifications Held
Other Professional Memberships
(You need not disclose membership in professional organizations that may reveal information regarding race, color, creed, sex religion, national origin, ancestry, age, disability, marital status, veteran status, or any other protected status)

References

Please furnish the names, addresses and telephone numbers of two people to whom you are not related and by whom you have not been employed:
Reference #1
Name*
Phone Number*
Please enter a valid phone number.
Address

Address

Street Address Line 2

CityState

Zip
Reference #2
Name*
Phone Number*
Please enter a valid phone number.
Address

Address

Street Address Line 2

CityState

Zip

PREVIOUS EMPLOYMENT (begin with most recent position):
Employer #1:
Firm*
Positions Held*
Dates of Employment:*
Address
Phone Number*
Please enter a valid phone number.
Supervisor*
Supervisor Title*
Responsibilities*
Starting Title*
Ending Title*
Reason for Leaving*
May we contact this employer for reference?*

YesNo
Employer #2:
Firm
Positions Held
Dates of Employment:
Address
Phone Number
Please enter a valid phone number.
Supervisor
Supervisor Title
Responsibilities
Starting Title
Ending Title
Reason for Leaving
May we contact this employer for reference?

YesNo
Employer #3:
Firm
Positions Held
Dates Employed
Address
Phone Number
Please enter a valid phone number.
Supervisor
Supervisor Title
Responsibilities
Starting Title
Ending Title
Reason for Leaving
May we contact this employer for reference?

YesNo

Signature Page
BW Electric, Inc. is an equal opportunity employer. BW Electric, Inc. does not discriminate in employment on account of race, color, religion, national origin, citizenship status, ancestry, age, sex (including sexual harassment), sexual orientation, marital status, physical or mental disability, military status, or unfavorable discharge from military service.

I understand that neither the completion of this application nor any other part of my consideration for employment establishes any obligation for BW Electric, Inc. to hire me. If am hired, I understand that either BW Electric, Inc. or I can terminate my employment at any time and for any reason, with or without cause and without prior notice. I understand that no representative of BW Electric, Inc. has the authority to make any assurance to the contrary.

I attest with my signature below that I have given to BW Electric, Inc. true and complete information on this application. No requested information has been concealed. I authorize BW Electric, Inc. to contact references provided for employment reference checks. If any information I have provided is untrue, or if I have concealed material information, I understand that this will constitute cause for the denial of employment or immediate dismissal.
Signature of Applicant*

Clear
Date*

MonthDayYear
Date

Pre-Offer Protected Veteran Self-Identification Form

This employer is a Government contractor subject to the Vietnam Era Veterans' Readjustment Assistance Act of 1974, as amended by the Jobs for Veterans Act of 2002, 38 U.S.C. 4212 (VEVRAA), which requires Government contractors to take affirmative action to employ and advance in employment: (1) disabled veterans; (2) recently separated veterans; (3) active duty wartime or campaign badge veterans; and (4) Armed Forces service medal veterans. These classifications are defined as follows:
1. A "disabled veteran" is one of the following: 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.
2. A "recently separated veteran" means 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.
3. An "active duty wartime or campaign badge veteran" means 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.
4. An "Armed forces service medal veteran" means 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.
Protected veterans may have additional rights under USERRA-the Uniformed Services Employment and Reemployment Rights Act. In particular, if you were absent from employment in order to perform service in the uniformed service, you may be entitled to be reemployed by your employer in the position you would have obtained with reasonable certainty if not for the absence due to service.

For more information, call the U.S. Department of Labor's Veterans Employment and Training Service (VETS), toll-free, at 1-866-4-USA-DOL.

If you believe you belong to any of the categories of protected veterans listed above, please indicate by checking the appropriate box below. As a Government contractor subject to VEVRAA, we request this information in order to measure the effectiveness of the outreach and positive recruitment efforts we undertake pursuant to VEVRAA.
Please select one:

I identify as one or more of the classifications of protected veteran listed above.I am not a protected veteran.I choose not to self-identify.
Print Name
Date

MonthDayYear
Date

Voluntary Self-Identification of Disability

OMB Control Number 1250-0005

Expires 04/30/2026
Name
Employee ID:
If applicable
Date

MonthDayYear
Date
Why are you being asked to complete this form?

We are a federal contractor or subcontractor. The law requires us to provide equal employment opportunity to qualified people with disabilities. We have a goal of having at least 7% of our workers as people with disabilities. The law says we must measure our progress towards this goal. To do this, we must ask applicants and employees if they have a disability or have ever had one. People can become disabled, so we need to ask this question at least every five years.

Completing this form is voluntary, and we hope that you will choose to do so. Your answer is confidential. No one who makes hiring decisions will see it. Your decision to complete the form and your answer will not harm you in any way. If you want to learn more about the law or this form, visit the U.S. Department of Labor's Office of Federal Contract Compliance Programs (OFCCP) website at www.dol.gov/ofccp.
How do you know if you have a disability?

A disability is a condition that substantially limits one or more of your "major life activities." If you have or have ever had such a condition, you are a person with a disability. Disabilities include, but are not limited to:
- Alcohol or other substance use disorder (not currently using drugs illegally)
- Autoimmune disorder, for example, lupus, fibromyalgia, rheumatoid arthritis, HIV/AIDS
- Blind or low vision
- Cancer (past or present)
- Cardiovascular or heart disease
- Cerebal Palsy
- Deaf or serious difficulty hearing
- Diabetes
- Disfigurement, for example, Nervous system condition, for example disfigurement caused by burns, wounds, accidents, or congenital disorders
- Epilepsy or other seizure disorder
- Gastrointestinal disorders, for example, Crohn's Disease, irritable bowel syndrome
- Intellectual or developmental disability
- Mental health conditions, for example, depression, bipolar disorder, anxiety disorder, schizophrenia, PTSD
- Missing limbs or partially missing limbs
- Mobility impairment, benefiting from the use of a wheelchair, scooter, walker, leg brace(s) and/or other supports
- Nervous system condition, for example, migraine headaches, Parkinson’s disease, multiple sclerosis (MS)
- Neurodivergence, for example, attention-deficit/hyperactivity disorder (ADHD), autism spectrum disorder, dyslexia, dyspraxia, other learning disabilities
- Partial or complete paralysis (any cause)
- Pulmonary or respiratory conditions, for example, tuberculosis, asthma, emphysema
- Short stature (dwarfism)
- Traumatic brain injury
Please check one of the boxes below:

Yes, I have a disability, or have had one in the pastNo, I do not have a disability and have not had one in the pastI do not want to answer
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B.W. Electric, Inc. Employment Application

APPLICANT DATA:

EDUCATION:

High School

College/University

Other

PROFESSIONAL LICENSE, CERTIFICATIONS OR MEMBERSHIP:

References

Reference #1

Reference #2

Employer #1:

Employer #2:

Employer #3:

Signature Page