PRELIMINARY QUESTIONNAIRE FOR EMPLOYMENT CONSIDERATION

Transcription

1 SOUTHERN LUMBER AND MILLWORK CORPORATION 2031 KING STREET P.O BOX CHARLESTON, SC (843) PRELIMINARY QUESTIONNAIRE FOR EMPLOYMENT CONSIDERATION Please Print and Sign Name Address City/State/Zip Phone: (Home) (Work) Present or Last Place of Employment Address City/State/Zip Your Present or Last Job Title Briefly Describe Your Present or Last Job s Responsibilities Briefly List Your Work Skills and Abilities Sign Page 1 of 8

2 -EMPLOYER S USE- APPLICATION -EMPLOYER S USE- FOR DEPARTMENT BUILDING MATERIAL BRANCH LOCATION EMPLOYMENT START DATE PAY (PLEASE ANSWER ALL QUESTIONS) POSITION NOTICE: Applicant should read the following information before filling out any of the questions in this form. Title VII of the Civil Rights Act of 1964, as amended, prohibits discrimination in employment because of race, color, sex, religion, disability, or national origin. It is also illegal to discriminate in employment of persons because of their age if over 40. This application is considered active for a period of thirty (30) days. If you have not heard from the company within thirty days and wish to receive further consideration for employment, you must reapply in person. WE ARE AN EQUAL OPPORTUNITY EMPLOYER TODAY S DATE LAST NAME FIRST NAME MIDDLE NAME PRESENT ADDRESS CITY STATE ZIP CODE HOW LONG HAVE YOU LIVED AT THE ABOVE ADDRESS? YEARS MONTHS TELEPHONE NUMBER PREVIOUS ADDRESS (if less than 2 years at present) CITY STATE ZIP CODE YEARS MONTHS POSITION APPLIED FOR? DATE YOU CAN START? ARE YOU APPLYING FOR FULL TIME PART TIME TEMPORARY IN CASE OF EMERGENCY NOTIFY (NAME, PHONE, ADDRESS) REFERRED BY: SCHOOLING ELEMENTARY HIGH SCHOOL COLLEGE OR UNIVERSITY BUSINESS, TRADE OR MILITARY (Specify) EDUCATION NAME AND LOCATION OF SCHOOL GRADUATE YES NO CHECK KINDS OF WORK IN WHICH YOU HAVE HAD EXPERIENCE Accounting Data Processing Office Practices Building Material Sales Bookkeeping Truck Driving Building Material Purchasing Inside Cashier Forklift Operator Yard Outside Credit & Collections Building Material Mgmt. Warehouse Management LIST THE OFFICE SKILLS AND/OR PLANT AND SHOP MACHINES YOU ARE QUALIFIED TO OPERATE: Page 2 of 8

3 (APPLICANT TO ANSWER ONLY IF APPLYING AS A DRIVER OR VEHICLE OPERATOR) DO YOU HAVE YOUR COMMERCIAL DRIVER S LICENSE? YES NO CHECK THE TYPES OF VEHICLES YOU ARE QUALIFIED, THROUGH EXPERIENCE, TO OPERATE: PASSENGER CAR LIGHT TRUCK HEAVY TRUCK OR TRACTOR DRIVER S LICENSE NO. STATE EXPIRES OTHER: (specify) HAS YOUR LICENSE EVER BEEN SUSPENDED OR REVOKED? YES NO HOW MANY CONVICTIONS FOR MOVING VIOLATIONS WITHIN PAST 3 YEARS? FORMER EMPLOYERS (LIST PREVIOUS EMPLOYERS, STARTING WITH LAST ONE FIRST) DATES NAME AND ADDRESS OF EMPLOYER PHONE SALARY REASON FOR LEAVING TO TO TO TO IF EMPLOYED, ARE YOU WILLING TO TAKE A PHYSICAL EXAMINATION AT COMPANY EXPENSE? YES NO HAVE YOU EVER APPLIED TO THIS COMPANY BEFORE? YES NO ARE YOU NOW EMPLOYEED? YES NO IF NOW EMPLOYED, WHERE? MAY WE INQUIRE OF YOUR PAST & PRESENT EMPLOYERS? YES NO IF YES, TELEPHONE NUMBER I AUTHORIZE INVESTIGATION OF ALL STATEMENTS CONTAINED IN THIS APPLICATION. YES NO I HAVE READ THESE STATEMENTS AND ANSWERS TO THESE INQUIRIES. YES NO ARE YOU RESTRICTED FROM WORKING CERTAIN HOURS OF THE DAY? YES NO IF YES, INDICATE THE HOURS YOU ARE NOT AVAILABLE ARE YOU RESTRICTED FROM WORKING CERTAIN DAYS OF THE WEEK? YES NO IF YES, INDICATE THE DAYS AVAILABLE. M T W T F HAVE YOU EVER PLEADED GUILTY TO, NO CONTEST TO, OR BEEN CONVICTED OF A CRIME OTHER THAN A MINOR TRAFFIC VIOLATION? YES NO. IF YES, STATE CITATION, DATE, AND PLACE WHERE OFFENSE OCCURRED. (A YES ANSWER WILL NOT AUTOMATICALLY DISQUALIFY YOU FROM CONSIDERATION.) Page 3 of 8

4 SOUTHERN LUMBER AND MILLWORK CORPORATION 2031 KING STREET P.O BOX CHARLESTON, SC (843) As an applicant for employment with this company, I understand the following: Any misrepresentation or falsification of information or significant omissions will be cause for rejection of my application or for subsequent discipline up to and including my dismissal from employment if discovered at a later date. My employment is AT WILL, and may be terminated by the company or myself at any time with or without notice or reason. No management official is authorized to make any oral assurance or promise of continued employment. I authorize and consent to my current and prior employers, educational institutions and persons or organizations named in this application (or accompanying resume) to release any information that may be required to make an employment decision. My employment is contingent upon the results of a drug screening analysis for substance abuse. The results of such analysis may be grounds for disqualifying me or terminating my employment. If I am employed, I agree to comply with and be bound by the safety and health rules and regulations of conduct of the company. Signature of Applicant/Employee DO NOT WRITE EMPLOYER S USE ONLY EMPLOYERS: REMARKS: Page 4 of 8

5 THIS EMPLOYER PARTICIPATES IN E-VERIFY Federal law requires all employers to identify the identity and employment eligibility of all persons hired to work in the United States. Signature of Applicant/Employee Page 5 of 8

6 Corporate Policy on Substance Abuse and Substance Abuse Testing of Applicants and Employees All employees of Southern Lumber and Millwork Corp. are prohibited from possessing, swallowing, inhaling, injecting, dealing in, or otherwise using illegal drugs and substances (such as marijuana, cocaine, LSD, heroine, etc.) and prescription drugs which are not prescribed for the employee's own use. This prohibition applies to use at any time, both on the job and off the job. Company employees are, of course, permitted to possess any substance when required by their jobs or for the purpose of lawful delivery to another person. All employees are prohibited from reporting to work or being at work while under the influence of alcohol. Unless expressly authorized by the General Manager, employees are prohibited from bringing alcoholic beverages onto Company premises or into a Company vehicle. All applicants tentatively selected for employment with the Company shall be given a drug screen following a conditional offer of employment. Each such applicant shall sign and deliver to the Company a permission statement agreeing to such testing and acknowledging and stating his or her understanding that the testing will be conducted by an outside laboratory and that the results, as determined, are not the responsibility of the Company. An applicant who tests positive for the illegal use of drugs, or who fails to produce a valid sample for analysis, shall have his/her conditional offer of employment withdrawn by the Company. The individual may not apply for employment for a period of one year from the date of testing unless it is demonstrated that a rehabilitation program has been successfully completed. If the applicant has already started work at the time the unacceptable test results are received, employment may be terminated. Random testing of employees for drugs and/or alcohol may be conducted throughout the year. After an employee has been randomly selected for testing, his or her name or identification will be returned to the "random testing pool" for possible future selection. Any employee involved in a job-related accident which is recordable under OSHA regulations, reportable to our Workers' Compensation insurance carrier, results in off-site medical treatment, or results in an injury to another person or damage to property, whether or not he or she is deemed to be at fault, shall be tested for drugs and/or alcohol as soon as possible following such accident. A positive drug or alcohol test following such accident may also result in a delay or denial of Workers' Compensation benefits. If the conduct of an employee provides a reasonable suspicion that the employee may be under the influence of drugs and/or alcohol, the employee may be required to submit to a test for drugs and/or alcohol. An employee who tests positive for the presence of prescription drugs will be given an opportunity to present documentation from a physician that the employee was under the care of the physician and that the prescription drugs were being properly taken according to the orders of the physician at the time of the test. An employee who tests positive for the presence of alcohol or the use of illegal drugs following a reasonable suspicion or post-accident or injury drug/alcohol test may be subject to disciplinary action up to and including dismissal. An employee who tests positive as a result of a random drug or alcohol test may be given the option of termination or enrollment in and successful completion of a company-approved drug or alcohol rehabilitation program. Any costs for evaluation, assessment, or treatment will be the sole responsibility of the employee. At the discretion of management, the employee may be allowed to continue working during the treatment period, or may be placed on unpaid leave. Failure to comply with any of the terms or conditions of the rehabilitation program or after-care may result in immediate termination of employment. An employee who participates in the rehabilitation program will be subject to unannounced drug and/or alcohol tests for up to 24 months. A second positive drug or alcohol test under any circumstances may result in termination of employment. If an employee's test is positive, he/she may request a retest of the same sample. However, the cost of the retest will be the responsibility of the employee. Refusal to submit to a drug or alcohol screen or failure to produce a valid sample for analysis will be treated the same as a positive test result. THIS IS NOT A CONTRACT OF EMPLOYMENT. EMPLOYMENT REMAINS AT-WILL AND MAY BE TERMINATED BY EITHER PARTY AT ANY TIME, WITH OR WITHOUT NOTICE OR REASON. Signature of Applicant/Employee Page 6 of 8

7 Substance Abuse Policy Chemical Screening Consent an Release Form Applicant/Employee Name Social Security Number Street Address City, State Zip Telephone Number I hereby acknowledge that I have been informed of Southern Lumber and Millwork Corporation's Substance Abuse Policy and agree to be bound by this policy for purposes of applying for, accepting, or continuing employment with the Company. I understand and consent freely and voluntarily to the Company's request for a urine or other specimen or sample. I hereby release and hold harmless the Company, the medical review officer or other medical professionals, the laboratory their employees, agents and contractors from any liability arising from this request to furnish this or any specimen or sample, the testing of the specimen or sample, and any decisions made concerning my application for employment or my continued employment, based on the results of the tests. I consent to allow the laboratory, hospital, medical review officer or other medical professional to perform appropriate chemical tests for the presence of alcohol, drugs, or other controlled substances. I give my permission to any Company employee, laboratory, hospital, medical review officer or other medical professional to release the results of these tests to the Company and I release any such designated institution or person from any liability whatsoever arising from the release of this information. Examples of these circumstances include, but are not limited to: Disclosure required by law (federal, state, local). Lawsuits and similar proceedings. The company may use and/or disclose medical/health information in response to a court or administrative order or lawsuit or similar proceeding. The company may also disclose medical/health information in response to a discovery request, subpoena, or other lawful process by another party involved in a court or administrative proceeding. Medical/health information may be released during Workers' Comp and Unemployment Compensation proceedings, administrative hearings, and fact-finding conferences or discussions. The employee agrees to the release of information related to this policy for any of the reasons listed above, or for any other reason related to legitimate business interest of the company. Signature of Applicant/Employee Print Name Page 7 of 8

8 NOTICE OF OBTAINING BACKGROUND INFORMATION I understand that in connection with my application for employment or continued employment, the company may obtain a consumer report directly from a law enforcement agency, a credit reporting agency, or through a third party reporting agency. The term consumer report includes, but is not limited to: credit history, driving record, and criminal record. This information will be used solely for employment related purposes such as, but not limited to: evaluation for initial employment, promotions, transfers, or retention as an employee. I authorize the company to obtain a consumer report and I authorize any such reporting agencies to furnish the company any information it may have concerning me which is on record or otherwise. I understand that I may have the right to make a written request within a reasonable period of time to receive additional information about the nature and scope of this investigation in the event I am denied employment or my continued employment is adversely affected. I certify that the facts I have provided relative to my education, employment history, credit, driving and criminal background, as well as all other requested information is true and accurate. I understand that if I am employed and any such information has been omitted, found to be false in any respect, or a background report renders me unsuitable for the employment as determined at the sole discretion of the company, I may be terminated or no longer considered as an applicant. Applicant/Employee Signature Applicant/Employee Name Printed Social Security Number Driver s License Number of Birth Page 8 of 8