Bennett Electric & Industrial Contractors Inc. is a Drug Free Workplace. When applying for employment you must have photo identification.
BENNETT ELECTRIC AND INDUSTRIAL CONTRACTORS INC.
APPLICATION FOR EMPLOYMENT * DRUG FREE WORKPLACE
We consider applicants for all positions without regard to race, color, religion, sex, national origin, age, marital status, veteran status, the presence of a non-job-related medical condition or handicap, or any other legally protected status.
(PLEASE PRINT)
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POSITION(S) APPLYING FOR DATE OF APPLICATION
How did you learn about us?
r Advertisement r Friend r Walk-In
r Employment Agency r Relative r Other ________________________________________
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LAST NAME FIRST NAME MIDDLE NAME
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ADDRESS CITY STATE ZIP CODE
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TELEPHONE NUMBER(S) SOCIAL SECURITY #
If you are under 18 years of age, can you provide required proof of your eligibility to work?
r YES r NO
Have you ever filed an application with us before?
r YES r NO
If YES, give date: ___________________
Have you ever been employed with us before?
r YES r NO
If YES, give date: ___________________
Are you currently employed?
r YES r NO
May we contact your present employer?
r YES r NO
Are you prevented from lawfully becoming employed in this country because of Visa or Immigration Status? (Proof of citizenship or immigration status will be required upon employment)
r YES r NO
On what date are you available for work? ______________________________
Are you available to work : r Full Time r Part Time r Shift Work r Temporary
Are you currently on “lay-off” status and subject to recall?
r YES r NO
Can you travel if a job requires it?
r YES r NO
Have you been convicted of a felony within the last 7 years?
(Conviction does not necessarily disqualify applicant from employment)
r YES r NO
If YES, please explain: _______________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
Starting with your present or last job, include any job-related military service assignments and/or volunteer activities. You may exclude any organizations which indicate race, color, religion, national origin, handicap or other protected status.
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Employer Name Employer Address Employee Phone #
Dates Employed: From ____________________ To ____________________
Job Title: ________________________________ Supervisor: _________________________________
Hourly Rate/Salary: Starting $____________________ Final $____________________
Work Performed: ____________________________________________________________________
__________________________________________________________________________________
Reason for Leaving: __________________________________________________________________
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Employer Name Employer Address Employee Phone #
Dates Employed: From ____________________ To ____________________
Job Title: ________________________________ Supervisor: _________________________________
Hourly Rate/Salary: Starting $____________________ Final $____________________
Work Performed: ____________________________________________________________________
__________________________________________________________________________________
Reason for Leaving: __________________________________________________________________
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__________________________________________________________________________________
Employer Name Employer Address Employee Phone #
Dates Employed: From ____________________ To ____________________
Job Title: ________________________________ Supervisor: _________________________________
Hourly Rate/Salary: Starting $____________________ Final $____________________
Work Performed: ____________________________________________________________________
__________________________________________________________________________________
Reason for Leaving: __________________________________________________________________
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(IF YOU NEED ADDITIONAL SPACE, PLEASE CONTINUE ON A SEPARATE SHEET OF PAPER)
Special Skills and Qualifications
Summarize special job-related skills and qualifications acquired from employment or other experience.
__________________________________________________________________________________
__________________________________________________________________________________
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EDUCATION
__________________________________________________________________________________
High School Name High School Location
Years Completed: 9 10 11 12 r Diploma r Degree Other: ___________
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Undergraduate College/University Location
Years Completed: 1 2 3 4 r Diploma r Degree Other: ____________
Describe Course Study : _______________________________________________________________
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Describe any specialized training, apprenticeship, skills and extra-curricular activities: ________________
__________________________________________________________________________________
Describe any honors you have received:___________________________________________________
State any additional information you feel may be helpful to us in considering your application:_________
__________________________________________________________________________________
Do you speak, read and/or write any foreign languages?
r YES r NO
List Professional, trade, business or civic activities and office held. (You may exclude memberships which would reveal sex, race, religion, national origin, age, ancestry, or handicap or other protected status)
__________________________________________________________________________________
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REFERENCES:
(Give name, address, and telephone number of (3) references who are NOT related to you and are not previous employers.)
(1) _______________________________________________________________________________
(2) _______________________________________________________________________________
(3) _______________________________________________________________________________
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Have you ever had any job-related training in the United States Military?
r YES r NO
If YES, please describe________________________________________________________________
Are you physically or otherwise unable to perform the duties of the job for which you are applying?
r YES r NO
Are you willing to work at least (40) hours per week?
r YES r NO
If NO, please explain _________________________________________________________________
Are you willing to work overtime if necessary?
r YES r NO
Would you have any problems being at work on time at 7:00 a.m. each morning, except in emergency situations?
r YES r NO
Do you smoke?
r YES r NO
If YES, would you have any problems smoking in a designated area at normal break time?
r YES r NO
Do you have reliable transportation to get you to and from work?
r YES r NO
Do you have any relatives or affiliations with any electrical or mechanical contractors?
r YES r NO
Do you intend to move from the Valdosta area within the next (5) years?
r YES r NO
Do you have a telephone?
r YES r NO
If not, would it be a problem to get one? ___________________________________________________
List (if any) all traffic violations within the past (5) years. ______________________________________
__________________________________________________________________________________
Are you afraid or heights?
r YES r NO
Who should we notify in case of any emergency?
Name: ___________________________________
Phone: ___________________________________
Relationship: ______________________________
Would you consent to a polygraph (lie detector) test considering that the employee polygraph protection act permits polygraph testing, subject to restrictions, of certain employees of private firms who are reasonably suspected of involvement in a work place incident (theft, embezzlement, etc.) that resulted in economic loss to the employer?
r YES r NO
This application for employment shall be considered active for a period of time not to exceed 45 days. Any applicant wishing to be considered for employment beyond this time period should inquire as to whether or not applications are being accepted at that time.
I hereby understand and acknowledge that, unless otherwise defined by applicable law, any employment relationship with this organization is of an “at will” nature, which means that the Employee may resign at any time and the Employer may discharge Employee at any time with or without cause. It is further understood that this “at will” employment relationship may not be changed by any written document or by conduct unless such a change is specifically acknowledged in writing by an authorized executive of this organization. In the event of employment, I understand that false or misleading information given in my application or interview(s) may result in discharge. I understand, also, that I am required to abide by all rules and regulations of Employer.
Signature of Applicant: ____________________________________ Date: ______________________
CONSENT AND RELEASE FORM FOR DRUG AND ALCOHOL TESTING
Alcohol/Drug Policy
To protect the health and safety of all Bennett Electric and Industrial Contractors, Inc. employees, the following policies will go into effect February 8, 2000 concerning job-related accidents.
1. Use of or possession internally or externally of any alcohol or non-prescribed drugs while on company property or job site property will subject you to immediate dismissal.
NOTE: Do not bring, use, consume, or possess in any manner whatsoever any non-prescribed drugs or alcohol while you are on company or job site property. To do so could endanger your life or the life of a fellow employee and further, to do so will result in termination of your employment.
2. In the event of a job-related accident I will immediately fill out and sign the written authorization for test samples to be taken and test analysis to be made from my exhaled breath, blood and urine.
3. I understand as an employee of Bennett Electric I am required to be drug and alcohol tested in the event of a job-related accident and that I may be suspended until the test results are known.
4. Any work-related injuries requiring doctor’s attention will be drug and alcohol screened. I understand that a positive test will exonerate Bennett Electric and the Workman’s Compensation carrier for any liability (medical or any form of compensation expense) as a result of said accident; thus obligating me for any necessary medical cost as well as termination of employment.
5. Any employee whose test indicates the presence of any controlled substances regardless of the amount (unless prescribed writing by a medical doctor and validated in writing the physician as necessary medication) shall be terminated.
6. Any employee whose blood alcohol level test turns out to be .05% or higher shall be deemed under the influence of alcohol and will be terminated.
7. Employees who are required to take the test may be suspended until the test results are known.
8. I will hold the doctor, hospital staff, Bennett Electric, and the company I am assigned to harmless for the taking of any and all samples and testing.
9. I understand that failure or refusal to cooperate with the above-prescribed procedures for any reason shall constitute insubordination and/or admission of guilt and will be subject to immediate termination of employment.
Signature: _______________________________________ Date: ______________________________
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FOR PERSONNEL DEPARTMENT USE ONLY
Arrange Interview r YES r NO Employed r YES r NO
Remarks __________________________________________________________________________
__________________________________________________________________________________
Job Title __________________________ Hourly Rate/Salary __________ Department ______________
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