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)

 

________________________________________________________________________

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  ________________________________________

 

__________________________________________________________________________________

LAST NAME                                                      FIRST NAME                                      MIDDLE NAME

 

__________________________________________________________________________________

ADDRESS                                                            CITY                                    STATE            ZIP CODE

 

__________________________________________________________________________________

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.

 

__________________________________________________________________________________

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: __________________________________________________________________

 

===========================================================================

 

__________________________________________________________________________________

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.

 

__________________________________________________________________________________

 

__________________________________________________________________________________

 

__________________________________________________________________________________

 

EDUCATION

 

__________________________________________________________________________________

High School Name                                                                                                    High School Location

 

Years Completed:     9     10     11     12                             r  Diploma       r  Degree       Other: ___________

 

===========================================================================

 

 

__________________________________________________________________________________

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)

 

__________________________________________________________________________________

 

__________________________________________________________________________________

 

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 ______________

 

 

 

©Copyright Bennett Electric & Industrial Contractors, Inc. All Rights Reserved.