Application for Employment - Morgan Keller · APPLICATION FOR EMPLOYMENT Morgan-Keller is an equal...
Transcript of Application for Employment - Morgan Keller · APPLICATION FOR EMPLOYMENT Morgan-Keller is an equal...
APPLICATION FOR EMPLOYMENT Morgan-Keller is an equal opportunity employer and does not discriminate on the basis of race, religion, color, national origin, age, sex, gender, disability or any other characteristic protected by law.
INTRODUCTORY INFORMATION: Name: ____________________________________________________ Date: _______________________ Address: _______________________________________________________________________________________ City: _____________________ State: _______ Zip: __________ Phone: _________________
APPLICANT QUESTIONS: Type of worked desired: _______________ Salary desired: ___________ Date Available: _________ If hired, can you provide documents required to establish your eligibility to work in the U.S.? __ Yes __ No Are you 18 years of age or older? __ Yes __ No How were you referred to Morgan-Keller? _______________________________________________________ Have you ever been convicted of, or pled guilty or no contest to, a crime other than a minor traffic violation? __Yes __No If yes, please explain in detail on a separate piece of paper and include the date of final disposition of the case and the nature of the offense. This information will not necessarily disqualify you from employment but false or misleading information will. Factors such as age and time of the offense, seriousness and nature of the violation, and rehabilitation will be taken into account.
EDUCATION: High School or last grade completed: Name & Address of School: _________________________________________________________________________
Course of Study: _________________________ Number of years completed: ______________
Degree/Diploma: ______________________________________________________________________ College or Technical School Name & Address of School: _________________________________________________________________________
Course of Study: _________________________ Number of years completed: ______________ Degree/Diploma: ______________________________________________________________________ Other Schooling or Training Name & Address of School: _________________________________________________________________________
Course of Study: _________________________ Number of years completed: ______________
Degree/Diploma: ______________________________________________________________________
MILITARY EXPERIENCE: Branch of Service: _________________________________ From: __________ To: ___________
Rank/Type of Service: ____________________________________________________________________________ Special Training/Experience: ______________________________________________________________________ RECORD OF EMPLOYMENT: List positions starting with most recent: ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- Employer: _____________________________________________ Telephone: _____________________________
Address: ________________________________________________________________________________________
Position Title: __________________________________ Supervisor: ________________________________________
Start Date: _________ Date Left: __________ Beginning Salary: __________ Ending Salary: __________
Duties: ________________________________________________________________________________________
Reason for Leaving: ______________________________________________________________________________ ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- Employer: _____________________________________________ Telephone: _____________________________
Address: ________________________________________________________________________________________
Position Title: __________________________________ Supervisor: ________________________________________
Start Date: _________ Date Left: __________ Beginning Salary: __________ Ending Salary: __________
Duties: ________________________________________________________________________________________
Reason for Leaving: ______________________________________________________________________________ ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- Employer: _____________________________________________ Telephone: _____________________________
Address: ________________________________________________________________________________________
Position Title: __________________________________ Supervisor: ________________________________________
Start Date: _________ Date Left: ___________ Beginning Salary: _________ Ending Salary: _________
Duties: ________________________________________________________________________________________
Reason for Leaving: ______________________________________________________________________________ WORK-RELATED REFERENCES: (Do not include relatives) Name Occupation Years Known Contact Information
1. ____________________ _________________ _____________ ___________________________________________
2. ____________________ _________________ _____________ ___________________________________________
3. __________________ _______________ ____________ _______________________________________
PROFESSIONAL LICENSES AND MEMBERSHIPS Name of Organization Type of License Held Expiration Date __________________________________ _________________________ _______________ __________________________________ _________________________ _______________ __________________________________ _________________________ _______________
STATEMENT (Please read this statement carefully before signing this application):
I understand that employment with Morgan-Keller (the Company) is at-will, meaning that I or the Company may terminate my employment at any time, or for any reason consistent with applicable state or federal law.
I authorize the Company to conduct a thorough background investigation of my work and personal history, and verify all data given on this application and during interviews. I hereby release the Company, and its representatives or agents, from any liability that might result from such an investigation. I authorize all individuals, schools, and firms named to provide any requested information and release them from all liability for providing the requested information.
I consent to take any physical examinations, including but not limited to tests for alcohol or drugs, that may be requested by Morgan-Keller, Inc., (1) following an offer of employment and prior to commencement of work; and (2) during the course of my employment, consistent with applicable law, including but not limited to the American with Disabilities Act. I further authorize any health care professional who performs such an examination or who has other information concerning my physical, mental or other medical status to release such information to Morgan-Keller, Inc.
I understand this application will be active for a period of 90 days; after that time, if I wish to be considered for employment, I must submit a new application. I certify that all the statements in this completed application are true and understand that any falsification or willful omission shall be sufficient cause for dismissal or refusal to hire. Signature of Applicant: ___________________________________ Date Signed: ________________________
Para informacion en espanol, visite www.ftc.gov/credit o escribe a la FTC Consumer Response Center, Room 130-A 600 Pennsylvania Ave. N.W., Washington, D.C. 20580.
EEOC Affirmative Action Form
We are an equal opportunity employer and do not discriminate on the basis of race, color, religion, sex , sexual orientation, age, national origin, disability, veteran status or any other classification protected by federal, state, or local law. The information below will be used only in compilation for Affirmative Action reporting.
Government agencies require reports on status of applicants. This data is for analysis and affirmative action only. Submission is voluntary. Failure to supply this information will not jeopardize or adversely affect any consideration you may receive for employment or later advancement in employment.
Sex: ____ Male ___ Female Race/ethnicity:
___ Hispanic or Latino – A person of Cuban, Mexican, Puerto Rican, South or Central American, or other Spanish culture or origin regardless of race.
___ White (Not Hispanic or Latino) – A person having origins in any of the original peoples of Europe, the Middle East, or North Africa.
___ Black or African American (Not Hispanic or Latino) – A person having origins in any of the black racial groups of Africa.
___ Native Hawaiian or Other Pacific Islander (Not Hispanic or Latino) – A person having rigins in any of the peoples of Hawaii, Guam, Samoa, or other Pacific Islands.
___ Asian (Not Hispanic or Latino) – A person having origins in any of the original peoples of the Far East, Southeast Asia, or the Indian Subcontinent, including, for example, Cambodia, China, India, Japan, Korea, Malaysia, Pakistan, the Philippine Islands, Thailand, and Vietnam.
___ American Indian or Alaska Native (Not Hispanic or Latino) – A person having origins in any of the original peoples of North and South America (including Central America), and who maintain tribal affiliation or community attachment.
___ Two or More Races (Not Hispanic or Latino) – All persons who identify with more than one of the above five races.
___ Veteran: ____ Non-veteran
CandidateDisclosure,Authorization&ConsentfortheProcurementofConsumerReports
SectionI:Disclosure
(the“Company”)mayrequestbackgroundinformationaboutyoufromaconsumerreportingagencyinconnectionwithyouremploymentapplicationandforemploymentpurposes.ThereportorderedisdefinedbytheFairCreditReportingAct(FCRA)asaConsumerReport,andallinquiriesarelimitedtoinformationthataffectsjobperformanceandtheworkplace.ItisconductedinaccordancewithapplicablefederalandstatelawsincludingtheFCRA.Thescreeningwillbeconductedbyanoutsideagency—GoodHire,LLC.–Address:P.O.Box391403Omaha,NE68139|Phone:1-888-906-7351|Fax:650-362-1933|Email:[email protected],GoodHiremayobtainaConsumerReportonyouasanapplicantorduringemployment.
Aconsumerreportisacompilationofinformationthatmightaffectyouremployability.Thescopeofthereportmayincludeinformationconcerningyourdrivingrecord,civilandcriminalcourtrecords,credit,drugscreeningresults,worker’scompensationrecord,education,credentials,identity,pastaddresses,socialsecuritynumber,previousemploymentandpersonalreferences.
Shouldanemployerrelyuponaconsumerreportforanadverseaction,theFCRAmandatesyoubeprovidedwithacopyoftheconsumerreportandasummaryofyourrights.Anadverseactionisdefinedas“adenialofemploymentoranyotherdecisionforemploymentpurposesthatadverselyaffectsanycurrentorprospectiveemployee.”
SectionII:AuthorizationandReleaseIhavecarefullyreadandunderstandthisCandidateDisclosure,Authorization&ConsentfortheProcurementofConsumerReportsformandtheattachedsummaryofrightsundertheFairCreditReportingActBymysignaturebelow,Iconsenttothereleaseofconsumerreportsandinvestigativeconsumerreportspreparedbyaconsumerreportingagency,GoodHire,LLC.,totheCompanyanditsdesignatedrepresentativesandagents.Bymysignaturebelow,Iauthorizethecompanytosharethecontentsofthisconsumerreportorinvestigativeconsumerreportwithitspartnersandclientsinanefforttoplacemeintoanemployment/independentcontractorrelationshipwiththosepartners.IunderstandthatiftheCompanyhiresme,myconsentwillapply,andtheCompanymayobtainreports,throughoutmyemployment.Ialsounderstandthatinformationcontainedinmyjobapplicationorotherwisedisclosedbymebeforeorduringmyemployment,ifany,maybeusedforthepurposeofobtainingconsumerreportsand/orinvestigativeconsumerreports.Bymysignaturebelow,Iauthorizelawenforcementagencies,learninginstitutions(includingpublicandprivateschoolsanduniversities),informationservicebureaus,creditbureaus,record/datarepositories,courts(federal,stateandlocal),motorvehiclerecordsagencies,mypastorpresentemployers,themilitary,andotherindividualsandsourcestofurnishanyandallinformationonmethatisrequestedbytheconsumerreportingagency.Bymysignaturebelow,IcertifytheinformationIprovidedonthisformistrueandcorrectandwillbevalidforanyreportsthatmayberequestedbyoronbehalfoftheCompany.
IauthorizeGoodHireanditsagentstocontactmycurrentemployerifnecessarytoverifymycurrentemploymentstatusafterthefollowingdate:
ApplicantName:________________________________ ApplicantEmail:__________________________
ApplicantSignature:_____________________________ Date:___________________
CheckthisboxtoreceiveafreecopyofanyConsumerReport,InvestigativeConsumerReportorCreditReportfromGoodHireelectronically.Forapapercopy,[email protected].
SectionIII:ASummaryofRightsUnderTheFCRAParainformaciónenespañol,visitewww.consumerfinance.gov/learnmoreoescribeala ConsumerFinancialProtectionBureau,1700GStreetN.W.,Washington,DC20552.ThefederalFairCreditReportingAct(FCRA)promotestheaccuracy,fairness,and privacyofinformationinthefilesofconsumerreportingagencies.Therearemanytypesof consumerreportingagencies,includingcreditbureausandspecialtyagencies(suchasagencies thatsellinformationaboutcheckwritinghistories,medicalrecords,andrentalhistoryrecords). HereisasummaryofyourmajorrightsundertheFCRA.Formoreinformation,including informationaboutadditionalrights,gotowww.consumerfinance.gov/learnmoreorwrite to:ConsumerFinancialProtectionBureau,1700GStreetN.W.,Washington,DC20552.• Youmustbetoldifinformationinyourfilehasbeenusedagainstyou.Anyonewhouses acreditreportor
anothertypeofconsumerreporttodenyyourapplicationforcredit, insurance,oremployment–ortotakeanotheradverseactionagainstyou–musttellyou,and mustgiveyouthename,address,andphonenumberoftheagencythatprovidedthe information.
• Youhavetherighttoknowwhatisinyourfile.Youmayrequestandobtainallthe informationaboutyouinthefilesofaconsumerreportingagency(your“filedisclosure”). Youwillberequiredtoprovideproperidentification,whichmayincludeyourSocial Securitynumber.Inmanycases,thedisclosurewillbefree.Youareentitledtoafreefile disclosureif:
• apersonhastakenadverseactionagainstyoubecauseofinformationinyourcredit report;• youarethevictimofidentitytheftandplaceafraudalertinyourfile;• yourfilecontainsinaccurateinformationasaresultoffraud;• youareonpublicassistance;• youareunemployedbutexpecttoapplyforemploymentwithin60days.
Inaddition,allconsumersareentitledtoonefreedisclosureevery12monthsuponrequest fromeachnationwidecreditbureauandfromnationwidespecialtyconsumerreporting agencies.Seewww.consumerfinance.gov/learnmoreforadditionalinformation.
• Youhavetherighttoaskforacreditscore.Creditscoresarenumericalsummariesof yourcredit-worthinessbasedoninformationfromcreditbureaus.Youmayrequestacredit scorefromconsumerreportingagenciesthatcreatescoresordistributescoresusedin residentialrealpropertyloans,butyouwillhavetopayforit.Insomemortgagetransactions, youwillreceivecreditscoreinformationforfreefromthemortgagelender.
• Youhavetherighttodisputeincompleteorinaccurateinformation.Ifyouidentify informationinyourfilethatisincompleteorinaccurate,andreportittotheconsumer reportingagency,theagencymustinvestigateunlessyourdisputeisfrivolous.Seewww.consumerfinance.gov/learnmoreforanexplanationofdisputeprocedures.
• Consumerreportingagenciesmustcorrectordeleteinaccurate,incomplete,or unverifiableinformation.Inaccurate,incomplete,orunverifiableinformationmustbe removedorcorrected,usuallywithin30days.However,aconsumerreportingagencymay continuetoreportinformationithasverifiedasaccurate.
• Consumerreportingagenciesmaynotreportoutdatednegativeinformation.Inmostcases,aconsumerreportingagencymaynotreportnegativeinformationthatismorethansevenyearsold,orbankruptciesthataremorethan10yearsold.
• Accesstoyourfileislimited.Aconsumerreportingagencymayprovideinformationabout youonlytopeoplewithavalidneed--usuallytoconsideranapplicationwithacreditor, insurer,employer,landlord,orotherbusiness.TheFCRAspecifiesthosewithavalidneed foraccess.
• Youmustgiveyourconsentforreportstobeprovidedtoemployers.Aconsumer reportingagencymaynotgive
outinformationaboutyoutoyouremployer,orapotential employer,withoutyourwrittenconsentgiventotheemployer.Writtenconsentgenerallyis notrequiredinthetruckingindustry.Formoreinformation,gotowww.consumerfinance.gov/learnmore.
• Youmanylimit“prescreened”offersofcreditandinsuranceyougetbasedon informationinyourcreditreport.Unsolicited“prescreened”offersforcreditand insurancemustincludeatoll-freephonenumberyoucancallifyouchoosetoremoveyour nameandaddressfromtheliststheseoffersarebasedon.Youmayoptoutwiththenationwidecreditbureausat1-888-5-OPTOUT(1-888-567-8688).
• Youmayseekdamagesfromviolators.Ifaconsumerreportingagency,or,insomecases, auserofconsumer
reportsorafurnisherofinformationtoaconsumerreportingagency violatestheFCRA,youmaybeabletosueinstateorfederalcourt.
• Identitytheftvictimsandactivedutymilitarypersonnelhaveadditionalrights.For moreinformation,visit
www.consumerfinance.gov/learnmore.StatesmayenforcetheFCRA,andmanystateshavetheirownconsumerreportinglaws.In somecases,youmayhavemorerightsunderstatelaw.Formoreinformation,contactyour stateorlocalconsumerprotectionagencyoryourstateAttorneyGeneral.Forinformation aboutyourfederalrights,contact:
TYPEOFBUSINESS: PLEASECONTACT:
1.a.Banks,savingsassociations,andcredit unionswithtotalassetsofover$10billionand theiraffiliates
b.Suchaffiliatesthatarenotbanks,savingsassociations,orcreditunionsalsoshouldlist,inadditiontotheCFPB:
ConsumerFinancialProtectionBureau 1700GStreet,N.W.Washington,DC20552
FederalTradeCommission:ConsumerResponseCenter–FCRAWashington,DC20580(877)382-4357
2.Totheextentnotincludedinitem1above:a.Nationalbanks,federalsavingsassociations, andfederalbranchesandfederalagenciesof foreignbanks
b.Statememberbanks,branchesandagencies offoreignbanks(otherthanfederalbranches, federalagencies,andInsuredStateBranchesof ForeignBanks),commerciallending companiesownedorcontrolledbyforeign banks,andorganizationsoperatingundersection25or25AoftheFederalReserveAct
c.NonmemberInsuredBanks,InsuredState BranchesofForeignBanks,andinsuredstate savingsassociations
d.FederalCreditUnions
a.OfficeoftheComptrolleroftheCurrency CustomerAssistanceGroup1301McKinneyStreet,Suite3450Houston,TX77010-9050
b.FederalReserveConsumerHelpCenterP.O.Box.1200Minneapolis,MN55480
c.FDICConsumerResponseCenter 1100WalnutStreet,Box#11KansasCity,MO64106
d.NationalCreditUnionAdministration OfficeofConsumerProtection(OCP) DivisionofConsumerComplianceand Outreach(DCCO)1775DukeStreetAlexandria,VA22314
3.Aircarriers Asst.GeneralCounselforAviation Enforcement&ProceedingsAviationConsumerProtectionDivision DepartmentofTransportation1200NewJerseyAvenue,S.E.Washington,DC20590
4.CreditorsSubjecttotheSurface TransportationBoard
OfficeofProceedings,SurfaceTransportation BoardDepartmentofTransportation 395EStreet,S.W.Washington,DC20423
5.CreditorsSubjecttothePackersand StockyardsAct,1921
NearestPackersandStockyards Administrationareasupervisor
6.SmallBusinessInvestmentCompanies AssociateDeputyAdministratorforCapital AccessUnitedStatesSmallBusinessAdministration 409Third
Street,S.W.,8th FloorWashington,DC20416
7.BrokersandDealers SecuritiesandExchangeCommission 100FStreet,N.E.Washington,DC20549
8.FederalLandBanks,FederalLandBankAssociations,FederalIntermediateCredit Banks,andProductionCreditAssociations
FarmCreditAdministration 1501FarmCreditDriveMcLean,VA22102-5090
9.Retailers,FinanceCompanies,andAllOther CreditorsNotListedAbove
FTCRegionalOfficeforregioninwhichthe creditoroperatesorFederalTrade Commission:ConsumerResponseCenter– FCRAWashington,DC20580(877)382-4357