Equipment Operator Application

APPLICATION FOR EMPLOYMENT

Applicants for all positions will be considered without regard to race, color, religion, sex, national origin, age, marital status, disability, veteran or other protected status. This application is effective for sixty (60) days after application date. If you wish to be considered for employment after this time, you must reapply.
Full Name

First NameMiddle NameLast Name
Current Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Birth Date

MonthDayYear
Social Security Number
Phone Number
Format: (000) 000-0000.
Alternate Phone Number
Format: (000) 000-0000.
Position Applied For:
Date of Application

MonthDayYear
If under 18 years of age, can you provide required proof of eligibility to work?
Are you authorized to work in the United States? As a condition of employment, you are required to submit proof of employment eligibility and identity in compliance with the Immigration Reform and Control Act of 1986.
Have you ever been convicted of a crime, or have you ever pleaded no contest or had adjudication withheld in a criminal matter? If "Yes", please give date, place, and nature of crime. Each case is considered individually and will not necessarily disqualify the applicant.
Have you ever been named a defendant in a civil action alleging sexual harassment. assault, battery, stalking, intentional infliction of emotional distress. or any other intentional tort') If "Yes," please give date, place, nature ot the case and final outcome. Each case is considered individually and wi II ,wt necessarily disquc1li r·y the applicant.
If applying for a position that involves driving in the scope of employment, answer the following: Do you have a valid state driver's license? If"Yes," please type and state of issue.
Have you received any moving violations in the prior five years? If "Yes," list date, place and details of violations below. Each case is considered individually and will not necessarily disqualify the applicant.

Employment Experience

Report your entire work history, starting with your present or last job. Include any job related military assignments and voluntary activities and gaps in employment. ar assignments and voluntary activities and gaps in employment. Excludeorganizations that indicate race, color, religion, sex, age, national origin, marital status, disability, veteran, or other protected status.
Employer 1
Employer Name
Telephone Number
Please enter a valid phone number.Format: (000) 000-0000.
Employer Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Date Employed From

MonthDayYear
Date
Date Employed To

MonthDayYear
Date
Salary/Wage
Job Title
Supervisor Name

First NameLast Name
Work Preformed:
Reason For Leaving
Employer 2
Employer Name
Telephone Number
Please enter a valid phone number.Format: (000) 000-0000.
Employer Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Date Employed From

MonthDayYear
Date
Date Employed To

MonthDayYear
Date
Salary/Wage
Job Title
Supervisor Name

First NameLast Name
Work Preformed:
Reason For Leaving
Employer 3
Employer Name
Telephone Number
Please enter a valid phone number.Format: (000) 000-0000.
Employer Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Date Employed From

MonthDayYear
Date
Date Employed To

MonthDayYear
Date
Salary/Wage
Job Title
Supervisor Name

First NameLast Name
Work Preformed:
Reason For Leaving

Education
High School Education History
School Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Years Completed
Did you Graduate?
College Education History
School Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Did you Graduate?
Degree Earned
Other / Trade / Apprentice
School Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Skills / Certification
Honors Received
List business, trade, or civic activities or associations. You may exclude memberships that reveal race, color,religion, sex, age, national origin, marital status, disability, veteran, or other protected status.
Summarize special job-related skills and qualifications acquired from employment, military service, or other experience. List job-related certifications or experience.

References

Provide names, addresses and telephone numbers for three references who are not related to you and are not previous employers.
Reference 1
Reference 2
Reference 3

Motor Vehicle Report
Name

First NameLast Name
Birth Date

MonthDayYear
State
Licence Number
Original CDL Date

MonthDayYear
Date
# of Years Driving
Number of Years Hauling Logs, If no log hauling, what have you hauled in the last 3 years with a tractor/trailer
I understand that Motor Vehicle Reports may be obtained as a part of my employment. By checking yes on this disclosure, I hereby authorizethe Company to procure such reports and additional reports about me from time to time, as it deems appropriate, to evaluate my insurability.

Drug-Free Workplace Acknowledgement, Consent And Release

I agree to provide samples of my urine, blood, saliva, or other specimens as requested. I understand that the specimens will be examined only for the presence of drugs or alcohol, and tests designed to diagnose other diseases or conditions will not be performed on these samples.

I understand that submission to such testing is a condition of employment and disciplinary action up to and including termination of employment may result if: 1) I refuse to submit to such testing; 2) I refuse to execute all forms of consent and release of liability as are usually and reasonably attendant to such examinations; 3) There is evidence of tampering with a drug or alcohol test; 4) I have a confirmed positive test result; or 5) I otherwise violate the policy.

I understand the results of any such and all tests or searches are considered confidential communications. of drugs or alcohol or otherwise violate this policy, I understand Worker's Compensation medical and indemnity benefits may be denied pursuant to 440.102(5), Florida Statutes.I understand that the Drug-Free Workplace Policy and related documents are not intended to constitute a contract for employment between Burgundy Timber, Inc. and me, and that my employment is at-will and may be terminated at any time by either the Company orme, with or without cause or notice.

All complaints will be investigated promptly and the existence of a complaint will be disclosed only to the extent necessary to make a prompt and thorough investigation or to take appropriate corrective measures. fn all cases, the person who initiated the complaint wiU be informed of the findings and disposition of the matter at the conclusion of the investigation. Management will ensure that there is no coercion, retaliation, intimidation, discrimination or harassment directed against any individual who registers a complaint or serves as a witness on behalf of another individual.

PERSONS WHO ENGAGE IN PROHIBITED DISCRIMINATION OR HARASSMENT WILL BE SUBJECT TO DISCIPLINE UP TO AND INCLUDING TERMINATION OF EMPLOYMENT.
By checking below, I acknowledge my receipt and understanding of the BurgundyTimber, Inc. Drug Free Workplace Policy

Antidiscrimination & Anti- Harassment Policy

Burgundy Timber Inc. will not condone, permit or tolerate any form of discrimination and/or harassment by or against any employee, customer, vendor, independent contractor or other individual with whom our employees come in contact with in connection with their employment with Burgundy Timber, Inc. based upon age, race, creed, religion, sex, sexual orientation, national origin, disability or other protected class or characteristic established under applicable federal, state, or local statute or ordinance.

Sexual harassment is a form of illegal sex discrimination. Sexual harassment refers to behavior that is unwelcome, personally offensive, and which interferes with our work effectiveness. Federal law defines unlawful sexual harassment as unwelcome sexual advances, requests for sexual favors and other verbal or physical conduct of a sexual nature, whether by male or female, when (1) submission to such conduct is made either explicitly or implicitly a term or condition of an individual's employment, (2) submission to or rejection of such conduct by an individual is used as a basis for employment decisions affecting such individual, or (3) such conduct has the purpose or effect of unreasonably interfering with an individual's work performance or creating an intimidating, hostile or offensive work environment.

Individuals who believe they have been subjected to discrimination or harassment as described above or have questions about whether certain conduct is unlawful should immediately speak to .their supervisor or Clint Beckham. This is particularly important involving sexual harassment where there can be uncertainty about what is unlawful conduct.

Supervisors who receive complaints of discrimination or harassment or who are made aware of conduct that may constitute discrimination or harassment must immediately notify Clint Beckham.
By checking below, I acknowledge my receipt and understanding of the BurgundyTimber, Inc. Anti-Discrimination/Harassment Policy

Investigations and/or Searches Policy

The Company may conduct unannounced investigations, including searches of employees and their personal effects, for illegal drugs or other unauthorized items while on Company premises.

Employees and their vehicles are subject to search at any time while on Company property.

All personal items such as pockets, packages, bags, briefcases, lunch boxes, purses, tool boxes or other belongings being brought onto or removed from Company premises may be inspected by the Company or its authorized agents at any time. Company-assigned property such as lockers, desks, vehicles, etc., are also subject to inspection.

Employees who refuse to cooperate in any investigation, search, or screening, or who are found to be in possession of illegal drugs or other prohibited items, will be subject to disciplinary action up to and including termination.

Non-employees found to be in violation of Company policies in these matters will be immediately banned from Company premises and may be prohibited from having access to Company operations. Legal actions may be taken if the situation warrants.
I acknowledge that I have received, read, and understand the Burgundy Timber, Inc. Controlled Substance Abuse Policy. I understand that my employment with Burgundy Timber, Inc. is contingent on my compliance with this policy.I further understand that failure to comply with the provisions or guidelines of this policy is grounds for immediate disciplinary action, up to and including termination of employment.I certify that I have fully read and understand the policy before checking this acknowledgement.

Employment At-Will Policy

Employment with Burgundy Timber, Inc. is “at-will,” which means that either the employee or the Company may terminate the employment relationship at any time, with or without notice, and with or without cause.

No supervisor, manager, or representative of the Company has the authority to enter into any agreement that changes this at-will employment relationship, except in a written contract signed by the President of the Company.

Nothing in any policy, handbook, or communication should be interpreted as creating a contract of employment or guaranteeing employment for any specific duration.

By signing below, I acknowledge that I have read and understand the above Employment At-Will Policy and that no verbal statements or promises can alter this relationship.
I have read and understand the Employment At-Will Policy.
Should be Empty:

APPLICATION FOR EMPLOYMENT

Employment Experience

Employer 1

Employer 2

Employer 3

Education

High School Education History

College Education History

Other / Trade / Apprentice

References

Motor Vehicle Report