EMPLOYMENT APPLICATION EQUAL OPPORTUNITY EMPLOYER

APPLICANT INFORMATIONDATE:

LAST NAME: / FIRST NAME: / MI:
STREET ADDRESS: / APARTMENT/UNIT#
CITY: / STATE / ZIP
PHONE: / EMAIL ADDRESS:
POSITION APPLIED FOR: / DATE AVAILABLE: / DESIRED SALARY: $
If you are under 18 years of age, please specify your age ____ (This information will be used only for child labor law purposes).
Are there any days, shifts or hours you will not work?* ☐Yes ☐ No
If yes, please explain:
Are you available for out of town work?* ☐Yes ☐No / Will you work overtime, if required?* ☐Yes ☐No
*NOTE: It is not necessary for you to identify unavailability for work because of religious observance or practice or any other protected classification. Subsequent to any job offer, we will consider whether a reasonable accommodation can be made.
Are you a citizen of the United States? ☐Yes ☐No / If no, are you authorized to work in the U.S.? ☐ Yes ☐No
Have you ever worked for this company? ☐ Yes ☐No / If so, when?

EDUCATION

High School: / Address:
Did you graduate? ☐Yes ☐ No
College: / Address:
Did you graduate? ☐ Yes ☐ No / Degree:
Trade/Other / Address:
Did you graduate? ☐ Yes ☐ No / Degree/Certification/License:

REFERENCES (Please list three professional references)

Full Name: / Title:
Company: / Phone: ( )
Address:
Full Name: / Title:
Company: / Phone: ( )
Address:
Full Name: / Title:
Company: / Phone: ( )
Address:

PREVIOUS EMPLOYMENT

Company / Phone: ( )
Address: / Supervisor:
Job Title: / From: / To:
Responsibilities:
May we contact your previous supervisor for a reference? ☐ Yes ☐ No
Company / Phone: ( )
Address: / Supervisor:
Job Title: / From: / To:
Responsibilities:
May we contact your previous supervisor for a reference? ☐ Yes ☐ No
Company / Phone: ( )
Address: / Supervisor:
Job Title: / From: / To:
Responsibilities:
May we contact your previous supervisor for a reference? ☐ Yes ☐ No

MILITARY SERVICE (if applicable)

Branch: / From: / To:
Rank at Discharge: / Military Specialty:

Have you signed any non-competition or non-solicitation agreement or any other kind of agreement with any other employer that might restrict you from working for the Company (you will be required to furnish a copy of the agreement if you are being considered for hire)?

☐ Yes ☐ No

If yes, please explain: ______

______

______

DISCLAIMER AND SIGNATURE

“I certify that the facts contained in this application are true and complete to the best of my knowledge and understand that, if employed, falsified statements on this application shall be grounds for dismissal. I authorize investigation of all statements contained herein and the references and employers listed above to give you any and all information concerning my previous employment and any pertinent information they may have, personal or otherwise, and release the company from all liability for any damage that may result from utilization of such information. I also understand and agree that no representative of the company has any authority to enter into any agreement for employment for any specified period of time, or to make any agreement contrary to the foregoing, unless it is in writing and signed by an authorized company representative. This waiver does not permit the release or use of disability-related or medical information in a manner prohibited by the American with Disabilities Act (ADA) and other relevant federal and state laws.” I understand that this is an FAA certified facility. All employees must submit to pre-employment drug & alcohol screening, physical exam, and background check. I also understand that random drug & alcohol screenings may be required throughout the course of employment.

Signature / Date

NOTE: Employee/Applicant Self-ID form MUST be included with your application.

Employee/Applicant Self-Identification Form

Federal laws and regulations require us to report on our workforce by race, gender, and veteran status and to offer the opportunity for self-identification as to disabilities. Please assist us by completing this form. YOU ARE NOT REQUIRED TO PROVIDE THIS INFORMATION. Data which you provide shall be kept strictly confidential, except that (i) supervisors and managers may be informed regarding restrictions on the work or duties of disabled individuals and/or disabled veterans; (ii) first aid and safety personnel may be informed, to the extent appropriate, if the condition might require emergency treatment; and (iii) governmental officials reviewing the Company’s compliance status shall be informed.

Last Name: ______First Name: ______

Middle Initial: ______(Optional) Social Security Number: ______

Gender: Please check box next to the appropriate category.

☐Male☐Female

Race/Ethnicity: Please check one.

☐Hispanic or Latino☐White (Not Hispanic or Latino)

☐Black or African American (Not Hispanic or Latino)☐Asian (Not Hispanic or Latino)

☐Native Hawaiian or Other Pacific Islander (Not Hispanic or Latino)

☐American Indian or Alaska Native (Not Hispanic or Latino)

☐Two or More Races (Not Hispanic or Latino)

Veteran Status: Check all that apply.

☐I am a disabled veteran.

☐I am a recently separated veteranDate of discharge (MM/DD/YY) ______

☐I served on active duty during a war or in a campaign or expedition for which a campaign badge has been authorized.

☐I participated in a United States military operation for which an Armed Forces Service Medal was awarded, while serving on

active duty in the Armed Forces, pursuant to Executive Order No. 12985 (61 Fed. Reg. 1209).

Disability

☐I am an individual with a disability.*

* Categories consistent with 41 C.F.R. §60-300 & Form VETS-100A

☐I have received the form and decline to provide the requested information.

______

Print NameSignatureDate

SELF-IDENTIFICATION FORM DEFINITIONS

1. The term "Disabled Veteran" means –

A. a veteran 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; or

B. a person who was discharged or released from active duty because of a service-connected disability.

2. The term "Recently Separated Veteran" applies to any veteran during the three -year period beginning on the date of discharge or

release from active duty.

3. An “individual with a disability” means any person who (i) has a physical or mental impairment which substantially limits one or

more of such person’s major life activities; (ii) has a record of such impairment; or (iii) is regarded as having such impairment.

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