Job Application Form

Employment Application

WE ARE AN EQUAL OPPORTUNITY EMPLOYER. Applicants and employees are considered for positions and are evaluated without regard to mental or physical disability, race, color, religion, gender, national origin, age, genetic information, military or veteran status, sexual orientation, marital status or any other protected Federal, State/Province or Local status unrelated to the performance of the work involved.

Please answer all questions completely. Please do not provide any information not specifically requested on this Employment Application form.

Personal

Please fill in all personal information below.

First Name

Middle Name

Last Name

Address

Address Line 1

Address Line 2

City

State

Zip Code

Country

Primary Phone

Alternate Phone

Potential Start Date

How did you hear about us?

Have you ever been previously employed by SOLTECH?

Yes

From:

To:

Desired Salary

Yes

Employer 1

Employer Name

Employer Phone #

Start Date

End Date

Supervisor's Name

Supervisor's Title

Employment Type

Full-Time

Part-Time

Temporary

Job Title

Starting Salary

Ending Salary

Describe Major Duties

Reason For Leaving

Employer Address

Address Line 1

Address Line 2

City

State

Zip Code

Country

Employer 2

Employer Name

Employer Phone #

Start Date

End Date

Supervisor's Name

Supervisor's Title

Employment Type

Full-Time

Part-Time

Temporary

Job Title

Starting Salary

Ending Salary

Describe Major Duties

Reason For Leaving

Employer Address

Address Line 1

Address Line 2

City

State

Zip Code

Country

Employer 3

Employer Name

Employer Phone #

Start Date

End Date

Supervisor's Name

Supervisor's Title

Employment Type

Full-Time

Part-Time

Temporary

Job Title

Starting Salary

Ending Salary

Describe Major Duties

Reason For Leaving

Employer Address

Address Line 1

Address Line 2

City

State

Zip Code

Country

Employer 4

Employer Name

Employer Phone #

Start Date

End Date

Supervisor's Name

Supervisor's Title

Employment Type

Full-Time

Part-Time

Temporary

Job Title

Starting Salary

Ending Salary

Describe Major Duties

Reason For Leaving

Employer Address

Address Line 1

Address Line 2

City

State

Zip Code

Country

Summary

In a brief statement, in your own words, please describe why you are an ideal candidate for this position.

Military Service

If applicable, please fill in the fields below regarding time served in the military.

Branch

Start Date

End Date

Highest Rank

Duties

Branch

Start Date

End Date

Highest Rank

Duties

References

Please list at least 3 references below

Name

Current Company

Relationship

Phone #

E-mail

Name

Current Company

Relationship

Phone #

E-mail

Name

Current Company

Relationship

Phone #

E-mail

Name

Current Company

Relationship

Phone #

E-mail

Name

Current Company

Relationship

Phone #

E-mail

Criminal History

Have you ever been convicted of, pleaded guilty or nolo contendere to, or otherwise been found guilty of a misdemeanor or felony offense? (Do not include convictions that have been sealed, erased, statutorily eradicated, expunged or annulled by a court or by a youthful offender adjudication or convictions that resulted in a referral to and participation in a diversion program. Your conviction records will not automatically eliminate you from consideration for employment.)

Yes

If you answered "Yes," to the previous question, please explain.

PRE-EMPLOYMENT STATEMENT (Please read before signing form)

I understand that the organization will rely, in part, on the information I provide in this Employment Application in considering whether to hire me. I understand that it is important that I provide complete and accurate information and certify that I have done so. If the organization discovers at any time that I failed to completely and honestly provide any information requested of me in this Employment Application or during the interview process, I understand that my application will no longer be considered or, if I am working for the organization, that I will be subject to disciplinary action, up to and including termination of employment.

The organization is committed to compliance with the provisions of this nation’s immigration laws regarding verification of employment eligibility. Any offer of employment will be contingent upon your ability to provide legally sufficient documentation showing your eligibility to be employed by this organization. Applicants or employees that present fraudulent documents for employment verification purposes will be terminated.

I authorize the organization to contact anyone that it deems appropriate to verify the information I have provided or to further investigate my background, past performance and suitability for employment. I consent to being discussed by any person contacted by the organization and waive all rights to bring any action for defamation, invasion of privacy or any similar claim against anyone that provides information to the organization with a good faith belief that the information provided is true. I understand that the organization may choose to obtain background information about me from a consumer reporting agency. Before requesting a report from a consumer reporting agency, the organization will ask for my authorization. I understand that if I refuse to provide such authorization, my application for employment will not be considered.

I understand that this Employment Application is not an offer of employment. I understand that nothing contained in this Employment Application creates a contract between the organization and me for employment or any other benefit. No promises regarding employment have been made and I understand that no such promise or guarantee is binding upon the organization.

I understand that if I am hired, I will be an employee "at will," meaning I am not hired for any definite length of time and either I or the organization can terminate my employment at any time for any or no reason.

If employed, I understand and agree that the organization retains the sole right in its business judgment to modify, suspend, interpret, or cancel, in whole or in part, at any time, with or without any notice, any published or unpublished policy, practice, procedure, process, or benefit.

If employed, I understand that I may be required to comply with Federal, State/Province, or Local Data Privacy and other applicable regulations. I understand and agree to comply with such laws.

If employed, I understand that as a condition of employment that I may be required to agree to and sign the organization’s confidentiality, non-compete, and/or other similar agreements. I also agree to notify the organization during the pre-employment process of any confidentiality, non-compete, and/or other similar agreements that I may have already signed with current and/or former employers, or other potential conflict.

I understand that the technical processing and transmission of the application, including my personal information, may involve (a) transmissions over various networks, including the transfer of this information to the United States and/or other countries for storage, processing and use by , its affiliates, and their agents; and (b) changes to conform and adapt to technical requirements of connecting networks or devices. Accordingly, I agree to permit such parties to make such transmissions and changes, and hereby provide the necessary consent for the same.

Do you confirm that you have read and understand the terms of this pre-employment statement?

I confirm this as my digital signature

Date

CONFIDENTIAL

Employee EEO Self-Identification Form

Notice - Completion of this form is voluntary

We are an Affirmative Action, Equal Opportunity Employer. Our employment decisions are made without regard to race, color, religion, gender, national origin, age, disability, marital status, veteran or military status, or any other legally protected status. The purpose of this Employee EEO Self-Identification Form is to comply with federal government record-keeping and reporting requirements. Periodic reports are made to the government on the following information. The data you provide on this form will be kept confidential and used solely for analytical and reporting requirement purposes. This form is processed and maintained separately from your personnel file and is not used to make decisions about the terms and conditions of employment. Completion of this form is optional and voluntary. We appreciate your assistance.

Employee Name

Position Title

Social Security #: Last 4 Digits

Voluntary Self-Identification of Ethnicity, Race, and Gender

Ethnicity / Race

Hispanic / 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, North Africa, or the Middle East

Black / African American (Not Hispanic or Latino) - A person having origins in any of the Black racial groups of Africa

Native Hawaiian / Pacific Islander (Not Hispanic or Latino) - A person having origins 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

Native American or Alaskan 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 maintains tribal affiliation or community recognition

Two or More Races (Not Hispanic or Latino) - All persons who identify with more than one of the above five races

Sex / Gender Code

Male

Female

Non-Binary

THANKS FOR YOUR ASSISTANCE!

Voluntary Self-Identification of Veteran Status

This employer is a Government contractor subject to the Vietnam Era Veteran Readjustment Assistance Act of 1974, as amended by the Jobs for Veterans Act of 2002, 38 U.S.C. 4212 (VEVRAA), which requires Government contractors to take affirmative action to employ and advance in employment:

disabled veterans;
recently separated veterans;
active duty wartime or campaign badge veterans; and
Armed Forces service medal veterans

These classifications are defined as follow:

A disabled veteran is one of the following:

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

A recently separated veteran means any veteran during the three-year period beginning on the date of such veteran charge or release from active duty in the U.S. military, ground, naval, or air service.

An active duty wartime or campaign badge veteran means a veteran 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 under the laws administered by the Department of Defense.

An armed forces service medal veteran means 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.

Protected veterans may have additional rights under USERRA the Uniformed Services Employment and Reemployment Rights Act. In particular, if you were absent from employment in order to perform service in the uniformed service, you may be entitled to be reemployed by your employer in the position you would have obtained with reasonable
certainty if not for the absence due to service. For more information, call the U.S. Department of Labors Veterans Employment and Training Service (VETS), toll-free, at 18664USADOL.

As a Government contractor subject to VEVRAA, we are required to submit a report to the United States Department of Labor each year identifying the number of our employees belonging to each specified protected veteran category. If you believe you belong to any of the categories of protected veterans listed above, please indicate by checking the appropriate box below.

I BELOND TO THE FOLLOWING CLASSIFICATIONS OF PROTECTED VETERANS (CHOOSE ALL THAT APPLY))

DISABLED VETERAN

RECENTLY SEPARATED VETERAN

ACTIVE WARTIME OR CAMPAIGN BADGE VETERAN

ARMED FORCES SERVICE MEDAL VETERAN

I am a protected veteran, but I choose not ot self-identify the classifications to which I belong.

I am NOT a protected veteran.

If you are a disabled veteran it would assist us if you tell us whether there are accommodations we could make that would enable you to perform the essential functions of the job, including special equipment, changes in the physical layout of the job, changes in the way the job is customarily performed, provision of personal assistance services or other accommodations. This information will assist us in making reasonable accommodations for your disability.

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 Veteran Readjustment Assistance Act of 1974, as amended.

The information you submit will be kept confidential, except that (i) supervisors and managers may be informed regarding restrictions on the work or duties of disabled veterans, and regarding necessary accommodations; (ii) 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 (iii) Government officials engaged in enforcing laws administered by the Office of Federal Contract Compliance Programs, or enforcing the Americans with Disabilities Act, may be informed

Employee Name

Position Title

Voluntary Self-Identification of Disability

Form CC-305

OMB Control Number 1250-0005

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**. 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.

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

Date

Check below to verify that all information that you provided in the above forms is true and accurate, and that this form was completed by the applicant.

I confirm this as my digital signature

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 qual employment obligations of Federal contractors, visit the U.S. Department of Labor's Office of Federal Contract Compliance Programs (OFCCP) website at http://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.