Date* Referred By StateArmed Forces AmericaArmed ForcesArmed Forces PacificAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDistrict of ColumbiaDelawareFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNew HampshireNew JerseyNew MexicoNew YorkNevadaNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirgin IslandsVirginiaWashingtonWest VirginiaWisconsinWyoming Have you ever applied with US?* YesNo If you have previously applied, when? Are you legally eligible for employment in the United States? * YesNo Were you previously employed by US? YesNo If you have previously been employed at US, when (From)? If you have previously been employed at US, when (To)? Availability: * Full TimePart TimeShift Work - DaysShift Work - Nights If hired, on what date will you be available to begin work?* What method of transportation will you use to get to work?* Next Education - High School Number of High School Years Completed High School GPA Did you graduate High School? YesNo College Number of College Years Completed College GPA Did you graduate College? YesNo Trade, Business, or Correspondence School Number of Trade, Business, or Correspondence Years Completed Trade, Business, or Correspondence GPA Did you graduate Trade, Business, or Correspondence School? YesNo Summarize special job related experiences, skills, or qualifications that you feel would qualify you to work with US: Please list all equipment or machinery you can operate efficiently, and give the amount of experience for each: BackNext EMPLOYMENT HISTORY (start with most recent employer) Company Name Company Name Company Address StateArmed Forces AmericaArmed ForcesArmed Forces PacificAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDistrict of ColumbiaDelawareFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNew HampshireNew JerseyNew MexicoNew YorkNevadaNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirgin IslandsVirginiaWashingtonWest VirginiaWisconsinWyoming Duties Employment Date (From)? Employment Date (To)? Final Salary Reason for Leaving: -+ If you are currently employed, may we inquire of that employer? YesNo Have you ever been convicted of a crime in the past ten years, excluding misdemeanors and summary offenses, which has not been annulled or expunged or sealed by court? YesNo If yes, please provide dates and details: Are you physically, or otherwise, unable to perform the duties of the job for which you are applying? YesNo If yes, what can be done to accommodate your limitation(s)? Military History (If applicable) I authorize investigation of all statements contained in this application. If employed, any falsification or omission of facts on this application shall be grounds for dismissal. I understand and agree that acceptance of an offer of employment does not create a contractual obligation to employ me in the future. My employment is for no definite period of time and may be terminated at any time without previous notice. YesNo United Structures Reference Release Form THIS PAGE CONTAINS SENSITIVE INFORMATION, KEEP ONLY IN SECURE FILES, SEPARATE FROM PERSONNEL RECORDS DISCLOSURE AND CONSENT FORM RELEASE CONCERNING CONSUMER / INVESTIGATIGATIVE REPORTS In accordance with my right to privacy, I have been advised by United Structures (“Company”) that the information described below is required to assist in making an employment determination concerning myself and that the execution of this form is voluntary. I hereby authorize the company, when bearing this document, or a copy thereof, to obtain information from all personnel educational institutions, government agencies, to include The Department of Justice, Companies, corporations, credit reporting agencies, workers’ compensation information, law enforcement agencies or individuals relating to my past activities, to supply any and all information concerning my background, and release same from any liability resulting from providing such information. The information received may include, but is not limited to academic, job performance, attendance, personal history, financial records, credit reports, driving history, disciplinary and criminal records. I understand that I may request a copy of any report that is prepared regarding myself and may also request the nature and substance of all information about me contained in the files of the consumer reporting agency. I understand that proper identification will be required in order to obtain my report from the consumer reporting agency. I have carefully read and understand this Disclosure and Consent form and by my signature below, consent to the release of consumer and / or investigative consumer reports, as defined above. I further understand that any and all information contained in my job application or otherwise disclosed to the Company by me before, during or after my employment, if any, may be utilized for purpose of obtaining the consumer reports or investigative consumer reports requested by the Company. I understand that if the Company hires me, it may request a consumer report and / or an investigative consumer report about me, as defined above, for employment-related purposes during the course of my employment. I understand that my consent will apply throughout my employment, to the extent permitted by law, unless I revoke or cancel my consent by sending a signed letter or statement to the Company at any time. This Disclosure and Consent form, in original, faxed, photocopied or electronic form, will be valid for any reports that may be requested by the Company. YesNo For purpose of gathering this information, I agree to supply the following information, which may be required by law enforcement agencies and other entitles for positive identification purposes when checking records. It is confidential and will not be used for any other purpose. Date of Birth* Social Security Number* Driver's License Number* Drivers License State* Work Related references Reference First Name Last Name Employer Their Title Your Title Years Known Their Phone Number -+ BackNext United Structures, Inc. Applicant Data Record Various agencies of the United States Government require employers to maintain information on employees pertaining to factors such as race, sex, and type of position for which an individual applies. The information requested on this sheet is for compliance with certain record keeping requirements. The Company believes all persons are entitled to equal employment opportunities and does not discriminate against its employees or applicants for employment because of race, color, sex, religion, national origin, disability, veteran status, age, marital status or any other protected group status. As employers/government contractors, we comply with government regulations and affirmative action responsibilities. This data is will be kept in a Confidential File separate from the Application of Employment. Regulations issued by the United States Department of Labor with respect to disabled individuals, disabled veterans, and Vietnam era veterans require that Federal contractors provide an opportunity for self-identification. Such self-identification is submitted on a voluntary basis, on a confidential basis, for use only in accordance with regulations, and without subjecting the individual to adverse treatment. Date Of Birth* Gender MaleFemale Position Applied For* Date Referral Source: * AdvertisementRelativeFriendEmployment AgencyWalk InOther Race/Ethnic Data: * White (Non-Hispanic)Black (Non-Hispanic)HispanicAsian or Pacific IslanderAmerican Indian or Alaskan NativeI choose not to answer Disabled/Veteran Classification: DisabledVietnam Era VeteranOther VeteranSpecial Disabled Veteran (30% or more disability)Not Applicable Explanation of the Categories: White (Non-Hispanic origin): Persons having origins in any of the original peoples of Europe, North Africa or the Middle East. Black (Non-Hispanic): Persons having origins in any of the black racial groups of Africa. Asian or Pacific Islander: Persons having origins in any of the original peoples of the Far East, Southeast Asia, the Pacific Islands or the Indian subcontinent including, for example: China, Japan, Korea, the Philippines, Samoa, India, and Pakistan. Hispanic: All persons of Mexican, Puerto Rican, Cuban, Central or South America or other Spanish culture or origin. American Indian or Alaskan Native: Persons having origins in any of the original peoples of North America and who maintain cultural identification through tribal affiliation or community recognition. Disabled Individual: Federal regulations define a disabled person as one who (1) has a physical or mental impairment, which substantially limits one or more of such person’s major life activities, (2) has a history of impairment, or (3) is regarded as having such impairment. Vietnam Era Veteran: Federal regulations define a veteran of the Vietnam era as one who (1) served on active duty for a period of more than 180 days, any part of which occurred between August 5, 1964, and May 7, 1975, and was discharged for released with other than a dishonorable discharge, or (2) was discharged or released from active duty for a service connected disability if any part of such active duty was performed between August 5, 1964, and May 7, 1975. Special Disabled Veteran: Federal regulations define a special disabled veteran as one who (1) is entitled to compensation under laws administered by Veterans’ Administration for a disability rated 30% or more, or (2) was discharged or released from active duty because of a service-connected disability. Other Veteran: A veteran who served on active duty during a war or in a campaign or expedition for which a campaign badge has been authorized. BackNext United Structures, Inc. Drug-Free Workplace Policy Summary Read carefully, ask any questions you have, and initial each item separately on the line provided. I hereby acknowledge that I have read and understand the US Drug-Free Workplace Policy Summary. I have had the opportunity to read the Employer’s Drug-Free workplace program (Available in H. R.) and received satisfactory answers to any questions that I have. I have also received a copy of the list of over the counter and prescription drugs that could alter or affect the outcome of a drug test. Click here to review the list of over the counter and prescription drugs that could alter or affect the outcome of a drug test. I know that if I am taking a medicine that could affect my ability to perform my job (i.e., there are warning labels on the container), I must inform my supervisor immediately. I know that if I refuse to submit to a pre-employment drug test I will not be hired and my employment is conditioned upon a negative drug test result. I know that total compliance with the US Drug-Free Workplace Policy is a condition of continued employment. I know that if I refuse a reasonable suspicion, post-injury, post-accident, or fitness-for-duty or posttreatment drug or alcohol test I may lose my job, my unemployment benefits, and my workers’ compensation medical and indemnity benefits. I know that if I am injured, or cause or contribute, to the cause of an injury or an accident and test positive for drugs and alcohol I will be subject to discipline up to and including discharge. I know that if I enter into a treatment program for drug or alcohol abuse and test positive for drugs or alcohol following completion of the primary phase of my treatment I will be subject to discipline up to and including discharge. I know that I have the right to challenge any positive test result and that I must notify the laboratory that I am challenging the test result. I am responsible for any fees involved with this challenge. I know that if I am convicted of a drug related crime I must notify my supervisor within five working days. I agree to comply with the drug and alcohol testing requirements of the Employer’s Drug-Free Workplace Policy. I understand that I will pay an $18.00 fee for the drug test initially. I must submit the receipt to US immediately. Once the employee has completed thirty (30) days of employment, US will reimburse the $18.00. I give my informed consent for the release of drug and/or alcohol test results to US. I know that the US Drug-Free Workplace Policy does not constitute an employment contract between US and me. I hereby consent to allow the facility that US has contracted with to collect urine samples from me to determine the presence of illegal drugs in my body. I have read and understood each of the preceding items that I have initialed. I have had the opportunity question any items that I did not understand. I have voluntarily signed this form. I hereby refuse to submit to a drug test as part of the US Drug-Free Workplace Program. Applicant First Name Applicant Last Name Date Witness First Name Witness Last Name Upload Resume (Optional - max file size 100mb) [contact-form-7 404 "Not Found"]
