Applications accepted for available positions ONLY

APPLICATION SUBMITTAL INSTRUCTIONS

All employment applications must be submitted to Garner’s corporate office listed below to the attention of the HR department either in person or by fax, by

email or mail:

Garner Environmental Services, Inc. 1717 West 13th Street Deer Park, Tx 77536

ATTN: HR Department (281) 478-0814 fax [email protected]

Applications accepted for available positions ONLY

********APPLICANT PRE-SCREEN QUESTIONNAIRE*********

The attached questionnaire must be completed to determine your eligibility for employment per Garner Environmental policies

****************************************************

Please make sure the application is completed in full Please make sure items requiring initials are initialed, not checked

Please make sure application is signed and dated

Please DO NOT include copies of ID or certifications

Incomplete applications will not be considered

Rev 11.15.14

mailto:[email protected]

APPLICANT PRE-SCREEN QUESTIONNAIRE

Garner Environmental Services, Inc. is an Equal Opportunity / Affirmative Action Employer

APPLICANT MUST MEET THE FOLLOWING CRITERIA SET BY OUR INSURANCE CARRIER IN ORDER TO DRIVE A COMPANY VEHICLE:

(If applicant checks “No” to any of the following questions, applicant is not eligible for hire) Yes ____ No ____ Is Applicant a minimum Age of 21 years?

Yes ____ No ____ Does Applicant have a valid driver’s license (not suspended)?

Yes ____ No ____ Does Applicant have an acceptable driving record?

An “acceptable driving record” as defined by our insurance carrier criteria includes no violations for DWI, DUI, OWI, OUT, refusing substance test, reckless driving, manslaughter, hit &run, eluding a police office, any felony, drag racing, license suspension, driving while license suspended, etc., for the previous 5 years. It also includes no more than one moving violation, which includes all vehicle accidents, speeding, improper lane change, failure to yield, running red lights or stop lights, etc., in the previous 3 years.

APPLICANT MUST SUCCESSFULLY PASS AN EXTENSIVE BACKGROUND CHECK PER OUR DISA BACKGROUND CRITERIA IN ORDER TO ENTER MOST PLANTS AND FACILITIES WE SERVICE:

(If applicant checks “Yes” to any of the following questions, applicant is not eligible for hire) Yes ____ No ____ Does Applicant have a felony conviction or felony conviction disposition in the past 7

years? Yes ____ No ____ Does Applicant have a misdemeanor conviction or misdemeanor conviction disposition

involving violence in the past 7 years? Yes ____ No ____ Does Applicant have a misdemeanor conviction or misdemeanor conviction disposition

involving moral turpitude (dishonesty, fraud, theft, etc.) in the past 7 years? DISA scores each background according to the criteria provided by plant and facilities we service. A “Yes” answer to any of the above would prevent entry into most of these plants and facilities.

APPLICANT IS REQUIRED TO SUCCESSFULLY PASS A PRE-EMPLOYMENT PHYSICAL AND DRUG SCREEN PER COMPANY POLICY:

Applicant will have to successfully pass a pre-employment physical and drug screen which includes hair follicle testing.

GARNER ENVIRONMENTAL POSITIONS REQUIRES A MINIMUM OF 50% TRAVEL (If applicant checks “No” to the following question, applicant is not eligible for hire)

Yes ____ No ____ Is Applicant willing to travel a minimum of 50%?

_______________________________________ __________________ Applicant Name - Signature Date

_______________________________________ Applicant Name - Printed

EQUAL OPPORTUNITY / AFFIRMATIVE ACTION EMPLOYER

Note: Applications will only be considered for 30 days from date above.

All questions must be answered completely or Applications will be not be considered.

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APPLICATION FOR EMPLOYMENT

P

E

R

S

O

N

A

L

Last Name First Name Middle Name Date

Street Address Home Telephone

( )

City, State, Zip Cell Phone

( )

Have you ever applied for employment with us?

Yes No If Yes: Month and Year ________Location_____________

Social Security #

Position Desired Pay Expected

$

Apart from absence for religious observance, are you available for full-time work?

Yes No If not, what hours can you work? _________________________

Will you work overtime if asked?

Yes No

Are you legally eligible for employment in the United States? Yes No When will you be available to

begin work? _______________

Other special training or skills (languages, machine operations, etc.) Please list all training and certifications and name as it

appears on driver license. ____________________________________________________________________________.

Please list driver license number: _______________________________ State: ____________ If CDL, type: _________.

Have you ever had a driver license with another number? Yes No If so, what number(s)? ___________________

Have you ever had a driver license in another state? Yes No If so, list all states and number(s)? _______________.

E

D

U

C

A

T

I

O

N

School

Name and Location of School

Course of

Study

No. Of

Years

Completed

Did You

Graduate?

Degree or

Diploma

Graduate

Yes

No

College

Yes

No

Business/Trade/Technical

Yes

No

High School

Yes

No

Elementary

Yes

No

Membership in Professional or Civic Organizations

(Exclude those which disclose your race, color, religion or national origin)

Prospective employees will

receive consideration without

discrimination because of race, creed, color, sex, age, national

origin, handicap or veteran

status.




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EMPLOYMENT Please give accurate, complete full-time and

part-time employment record. Start with your

present or most recent employer.

1

Company Name Telephone

( )

Address Employed – (State month and year)

From To

Name of Supervisor Weekly pay

Start Last

State Job Title and Describe Your Work Reason for Leaving

2


( ) Address Employed – (State month and year)

From To


Start Last


3



From To


Start Last


4



From To


Start Last


We may contact the employers listed

above unless you state truthfully that

you are still currently employed with

said employer.

Do Not Contact Current Employer listed below

Reason_______________________________________________

____________________________________________________

MILITARY

Did you serve in the

U.S. Armed Forces? Yes No

If “Yes” In, what Branch?

Describe any training received relevant to the position for which you are applying:




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The below information requested is needed for a legally permissible reason, including, without limitation, national

security considerations, a legitimate occupational qualification or business necessity. The Civil Rights Act of 1964

prohibits discrimination in employment because of race, color, religion, sex or national origin. Federal law also

prohibits discrimination based on age, citizenship and disability. The laws of most States also prohibit some or all

the above types of discrimination as well as some additional types as discrimination based upon ancestry, marital

status and sexual preference. Please Read and INITIAL each section as you answer to ensure no question is

missed.

Provide dates you attended school: Elementary

From To

Number of dependents, including yourself

will be requested if you are hired.

High School

From To

College

From To

Are you a US Military veteran?

Yes No

Other (give name and dates) Are you available to work nights?

Yes No

Is your U.S. Residence legal? Yes No Are you available to be on-call?

Yes No

What was your previous address? How long at present address?

__________ years

How long at previous address?

___________ years

Have you ever been bonded? Yes No

If “Yes”, with what employers?

Are you over 18 years of age?

Yes No

Have you ever been convicted of a felony or a misdemeanor involving violence or moral turpitude

(dishonesty, fraud, theft, etc)? Yes No

If “Yes”, describe in full – an application will not be considered if detailed information is not given. (A

conviction will not automatically disqualify an applicant for a particular job. The type and seriousness of

the crime, the frequency of violations, the applicant's age at the time of conviction, the date of conviction

and the applicant’s entire work and education and history will be considered.)

State names of relatives and friends working for us.

Please Read and INITIAL Each Paragraph Below (if there is any part of the following you do not

understand, please ask the interviewer about it before signing).

Please note: your application will not be considered if you fail to initial beside each Paragraph below.

I understand that consideration for employment in this position is contingent upon the results of a reference and

background check. I therefore authorize this company to investigate all statements made on my application for

employment, including but not limited to requesting a criminal background check and to discuss the results of its

investigations with those responsible for hiring. I further authorize the company to contact my former employer(s) and

any listed references or other persons who can verify information, and give my consent for former employers(s) and

other contacted persons to respond to questions pertaining to information on this application. Further, I release from

liability such former employer(s) or other persons contacted by and providing information to the company. In the event

I am hired, I authorize Garner Environmental Services, Inc. to request and obtain a background and/or criminal

background checks on me during my employment, with or without notice.




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I hereby authorize Garner Environmental Services, Inc. to thoroughly investigate my references, work

records, education and other matters related to my suitability for employment and, further, authorize my

current and former employers to disclose to the company any and all letters, reports, and other information

pertaining to my employment with them, without giving me prior notice of such disclosure. In addition, I

hereby release Garner Environmental Services, Inc., my current and former employers, and all other

persons, corporation, partnerships and associations from any and all claims, demands or liabilities arising

out of or in any related to such investigation or disclosure.

I understand that if offered employment, the offer may be contingent on my passing a pre-employment

alcohol and drug screen and a pre-employment physical. By signing this application, I voluntarily agree to

submit to a pre-employment alcohol/drug screen and pre-employment physical upon request. I understand

that failure to pass the alcohol/drug screen and/or physical will result in withdrawal of the employment

offer.

If hired, I also agree to submit to alcohol or drug testing as a condition of employment. I agree that Garner

Environmental Services, Inc. may conduct alcohol or drug screening at its discretion with or without notice.

I also understand that refusal to immediately submit to an alcohol/drug screen upon notice to do so will be

considered a voluntary resignation of employment and I will cooperate with Garner Environmental

Services, Inc. in connection with my voluntary discharge. If hired, I also agree to submit to alcohol or drug

testing if requested by a customer of Garner Environmental Services, Inc. I also understand that refusal to

submit to an alcohol/drug screen requested by a customer of Garner Environmental Services, Inc. will be

considered a voluntary resignation of my employment and I will cooperate with Garner Environmental

Services, Inc. in connection with my voluntary discharge.

I hereby understand and acknowledge that it is the policy of Garner Environmental Services, Inc. as well as

companies and customers for which Garner Environmental Services, Inc. performs services: (1) to prohibit

the use, possession, sale, and distribution of alcohol, illegal drugs, or other controlled substances on its

premises; and, (2) to prohibit the presence on company property or customer property, including but not

limited to offices, worksite or vehicles, of any employee, subcontractor, or agent of company who has such

substances in his/her body for non-medical reasons. I understand and agree that entry onto company

property or premises constitutes consent to an inspection of the employee, subcontractor, agent, including

vehicles and personal effects when entering, while on, or upon leaving company property. I understand that

any employee, subcontractor or agent who is found in violation of this policy may be subject to disciplinary

action up to and including discharge. I further understand and acknowledge that my refusal to submit to a

search and/or a blood and/or drug and/or alcohol test or screen upon request by either Garner Environmental

Services, Inc. or any company or customer for which Garner Environmental Services, Inc. provides services

will subject me to immediate termination. I further acknowledge that I am hereby notified that: companies

for which Garner Environmental Services, Inc. performs services have adopted same or similar policies

prohibiting drug and alcohol use and/or the presence of drug and/or alcohol in or on an employee or agent

of company. Employees or agents, by virtue of their association with Garner Environmental Services, Inc.,

may be subject to random drug and alcohol testing administered at the request of a company for which

services are performed. Employees who are administered a random drug test whether at the request of

Garner Environmental Services, Inc. and/or a company for which services are performed and who test

positively for the presence of alcohol and/or drugs will be subject to disciplinary action up to and including

immediate discharge.

I understand and agree that any future changes in my title, duties, compensation, working conditions, and/or

Garner Environmental Services, Inc. benefits, policies and procedures will not alter our at-will employment

agreement.

I understand that if offered employment, I will, as a condition of employment, be required to submit proof

of my identity and legal right to work in the United States on my first day of employment.




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If the position applied for requires driving in the course of work, I understand that I will be required to

possess a current and valid driver’s license and understand that I will be required to provide a copy of my

official driving record and proof of insurance. I also understand that any offer of employment is contingent

on my ability to be covered by Garner Environmental Services, Inc. auto insurance, if required for my

position. I hereby authorize Garner Environmental Services, Inc to obtain information on my automobile

driving history by requesting my driving record from the appropriate or any state department. I further

understand and acknowledge that in the event I am hired, Garner Environmental Services, Inc. will obtain

my driving record from the appropriate state agency from time to time in Garner Environmental Services,

Inc discretion, and I hereby authorize Garner Environmental Services, Inc. to obtain my driving record in its

discretion during my employment from time to time, without notice, if I am hired.

I further agree to sign an authorization for prospective employer to obtain consumer report for employment

purposes in the form attached hereto. I understand that my application for employment will not be

considered unless I sign the attached authorization. I further agree that in the event I am hired, Garner

Environmental Services, Inc. may obtain my consumer report and/or consumer credit report from an

appropriate agency and/or credit agency from time to time in Garner Environmental Services, Inc.'s sole

discretion, and I hereby authorize Garner Environmental Services, Inc. to obtain my consumer report and/or

consumer credit report in its sole discretion during my employment from time to time, without notice, if I

am hired.

I understand that nothing contained in the application or conveyed to me during my interview, which may

be granted, is intended to create an employment contract, implied or explicit, between Garner

Environmental Services, Inc and me. In addition, I understand and agree that if I am employed, my

employment relationship with Garner Environmental Services, Inc. is strictly voluntary and at our mutual

will. I understand that if employed, my employment is for no definite period and may be terminated at any

time, with or without prior notice, with or without cause or reason, at the option of either myself or Garner

Environmental Services, Inc. and that no promises or representation contrary to the foregoing are binding on

Garner Environmental Services, Inc.

I hereby certify that I have not knowingly withheld any information that might adversely affect my chances

for employment and that the answers given by me are true and correct to the best of my knowledge. I

further certify that I, the undersigned applicant, have personally completed this application. I understand

that any omission or misstatement on this application or on any documents used to secure employment shall

be grounds for rejection of this application or for immediate discharge if I am employed, regardless of the

time elapsed before discovery.

My signature below certifies that I have read and understand this complete document, and agree

to the terms and conditions outlined in this document.

___________________________________ _______________________ Applicants Signature Date

Garner Environmental Services, Inc.

1717 W. 13th Street

Deer Park, Texas 77536

281.930.1200

www.garner-es.com

Revised 11/2014

http://www.garner-es.com/

APPLICANT’S DISCLOSURE AND ACKNOWLEDGMENT FORM

11.2014

In connection with and for the duration of my employment, if hired, I understand that Garner Environmental Services, Inc. (GESI) may obtain “consumer reports” and/or investigative consumer reports” for employment purposes that relate to my credit, criminal, driving, employment, or education history. This information will, in whole or in part, be obtained from DISA, Inc. Background Screening Services (DISA), 12600 Northborough Drive, Suite 300, Houston, Texas 77067, telephone 281-673-2449. These reports may include information as to my general reputation, character, personal characteristics, work habits, job performance, and experience, along with reasons for termination of past employment from previous employers. I understand that GESI will be requesting this information from various federal, state, county and other agencies or institutions, which maintain public and non-public records concerning my past activities relating to my driving, credit, civil, education, and other experiences. I further understand that I have the right to request, in writing, the nature and scope of any investigative consumer report and a Summary of Consumer Rights as prescribed by Section 606 of the Fair Credit Reporting Act. I acknowledge that, if a job offer is made, that the above “consumer reports” and/or “investigative consumer reports” may be obtained. I will submit the applicable consent forms provided by GESI in order to obtain the above mentioned information. __________________________________________________ Applicant Name – Printed __________________________________________________ Applicant Name – Signature _____________________________ Date

INVITATION TO SELF-IDENTIFY FOR PURPOSES OF EEOC & AFFIRMATIVE ACTION REPORTING Due to participation in government contracts, Garner Env is subject to certain governmental recordkeeping and reporting requirements. In order to comply with these laws, the company invites employees to voluntarily self-identify their race/ethnicity and gender status. Submission of this information is voluntary and refusal to provide it will not subject you to any adverse treatment. The information obtained will be kept confidential and may only be used in accordance with the provisions of applicable laws, executive orders, and regulations, including those that require the information to be summarized and reported to the federal government. When reported, data will not identify any specific individual. Please Check One: ____ Male ____ Female Please Check One: ____ 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 ____ Hispanic or Latino: a person of Cuban, Mexican, Chicano, Puerto Rica, South or Central

American or other Spanish culture or origin, regardless of race ____ Native Hawaiian or Other Pacific Islander (not Hispanic or Latino): a person having

origins in any of the original 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 South Central America, and who maintains tribal affiliation or community attachment

____ Two or More Races (not Hispanic or Latino) ____ Check here if you do not wish to participate Applicant Name (printed): ______________________________________________________ Applicant Signature: __________________________________________ Date: ___________

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Invitation to Self-Identify for Protected Veterans As an EEO/AA employer, GESI, Inc. is subject to the Vietnam Era Veterans’ Readjustment Assistance Act of 1974 (VEVRAA) which requires government contractors to take affirmative action to employ and advance veterans in employment. VEVRAA prohibits discrimination and requires affirmative action in all personnel practices regarding protected veterans. The statute covers disabled veterans, Armed Forces service medal veterans, recently separated veterans, and other veterans who served during a war, or in campaign or expedition for which a campaign badge has been authorized.

Please check all that apply:

_____ Disabled Veteran

_____ Special Disabled Veteran

_____ Veteran of the Vietnam era

_____Other Protected Veteran

_____ Armed Forces Service Medal Veteran

_____ Other Veteran

_____ Not a Veteran

_____ I do not wish to participate

Employee Name (printed): _________________________________ Date: __________________ Employee Signature: ___________________________________________________________ VETERAN CATEGORY DEFINITIONS: Disabled Veteran: 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. Special Disabled Veteran: 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 Department of Veterans' Affairs for a disability (A) rated at 30 percent or more, or (B) rated at 10 or 20 percent in the case of a veteran who has been determined under Section 38 U.S.C. 3106 to have a serious employment handicap or (ii) a person who was discharged or released from active duty because of a service connected disability. Veteran of the Vietnam era: a person who: served on active duty in the U.S. military, ground, naval or air service for a period of more than 180 days, and who was discharged or released there from with other than a dishonorable discharge, if any part of such active duty was performed: (A) in the Republic of Vietnam between February 28, 1961, and May 7, 1975; or (B) between August 5, 1964, and May 7, 1975, in all other cases; or was discharged or released from active duty in the U.S. military, ground, naval or air service for a service connected disability if any part of such active duty was performed (A) in the Republic of Vietnam between February 28, 1961, and May 7, 1975; or (B) between August 5, 1964, and May 7, 1975, in any other location.

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VETERAN CATEGORY DEFINITIONS: - continued Other Protected Veteran: veterans 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. For those with Internet access, the information required to make this determination is available at http://www.opm.gov/veterans/html/vgmedal2.htm. Armed Forces Service Medal Veteran: 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 (61 Fed. Reg. 1209) at http://www.opm.gov/veterans/html/vgmedal2.asp. Other Veteran: a veteran of the U.S. military, ground, naval or air service that is not included in one of the categories listed above. You may inform us of your desire to benefit under the program at this time and/or at any time in the future. Submission of this information is voluntary and refusal to provide it will not subject you to any adverse treatment. The information provided will be used only in ways that are not inconsistent with the Vietnam Era Veterans' Readjustment Assistance Act of 1974, as amended. The information you submit will be kept confidential, except that (1) supervisors and managers may be informed regarding restrictions on the work or duties of disabled veterans, and regarding necessary accommodations; (2) first aid and safety personnel may be informed, when and to the extent appropriate, if you have a condition that might require emergency treatment; and (3) Government officials engaged in enforcing laws administered by OFCCP, or enforcing the Americans with Disabilities Act, as amended, may be informed. It is the policy of Garner Environmental Services, Inc. [GESI] not to discriminate against any employee or applicant for employment because he or she is a protected veteran. A written copy of this Affirmative Action Program is available for inspection by any employee or applicant for employment, during normal business hours, in the Personnel Department. Interested persons should contact the Personnel Manager at 281.930.4439 for assistance. If you are a disabled veteran it would assist us if you tell us about (1) any special methods, skills, and procedures that qualify you for positions that you might not otherwise be able to do because of your disability so that you will be considered for any positions of that kind, and (2) any accommodations that we could make that would enable you to perform the job, including special equipment, changes in the physical layout of the job, elimination of certain duties relating to the job, provision of personal assistance services or other accommodations. This information will assist us in placing you in an appropriate position and in making accommodations for your disability.

http://www.opm.gov/veterans/html/vgmedal2.htm

http://www.opm.gov/veterans/html/vgmedal2.asp

__________________________ __________________

Voluntary Self-Identification of Disability

Form CC-305 OMB Control Number 1250-0005

Expires 1/31/2017 Page 1 of 2

Why are you being asked to complete this form?

Because we do business with the government, we must reach out to, hire, and provide equal opportunity to

qualified people with disabilities i To help us measure how well we are doing, we are asking you to tell us if you

have a disability or if you ever had a disability. Completing this form is voluntary, but we hope that you will

choose to fill it out. If you are applying for a job, any answer you give will be kept private and will not be used

against you in any way.

If you already work for us, your answer will not be used against you in any way. Because a person may

become disabled at any time, we are required to ask all of our employees to update their information every five

years. You may voluntarily self-identify as having a disability on this form without fear of any punishment

because you did not identify as having a disability earlier.

.

How do I know if I have a disability?

You are considered to have a disability if you have a physical or mental impairment or medical condition that

substantially limits a major life activity, or if you have a history or record of such an impairment or medical

condition.

Disabilities include, but are not limited to:

Blindness

Deafness Cancer Diabetes

Epilepsy

Autism

Cerebral palsy

HIV/AIDS

Schizophrenia

Muscular dystrophy

Bipolar disorder

Major depression

Multiple sclerosis (MS)

Missing limbs or partially missing limbs

Post-traumatic stress disorder (PTSD) Obsessive compulsive disorder Impairments requiring the use of a wheelchair

Intellectual disability (previously called mental retardation)

Please check one of the boxes below:

YES, I HAVE A DISABILITY (or previously had a disability)

NO, I DON’T HAVE A DISABILITY

I DON’T WISH TO ANSWER

Your Name Today’s Date

i

Voluntary Self-Identification of Disability

Form CC-305 OMB Control Number 1250-0005

Expires 1/31/2017 Page 2 of 2

Reasonable Accommodation Notice

Federal law requires employers to provide reasonable accommodation to qualified individuals with disabilities.

Please tell us if you require a reasonable accommodation to apply for a job or to perform your job. Examples

of reasonable accommodation include making a change to the application process or work procedures,

providing documents in an alternate format, using a sign language interpreter, or using specialized equipment.

Section 503 of the Rehabilitation Act of 1973, as amended. For more information about this form or the equal

employment obligations of Federal contractors, visit the U.S. Department of Labor’s Office of Federal Contract

Compliance Programs (OFCCP) website at www.dol.gov/ofccp.

PUBLIC BURDEN STATEMENT: According to the Paperwork Reduction Act of 1995 no persons are required

to respond to a collection of information unless such collection displays a valid OMB control number. This

survey should take about 5 minutes to complete.

www.dol.gov/ofccp

Applications accepted for available positions ONLY

Documents

Transcript of Applications accepted for available positions ONLY