Application Form Date MM DD YYYY Time Hour Minute Second AM PM Phone (###) ### #### Email Position applying for Please select one of the following options. Select Carpenter Metal framer Finisher Procurement Manager Other INFORMATION Name * First Name Last Name Address * Address 1 Address 2 City State/Province Zip/Postal Code Country EMERGENCY CONTACT INFORMATION Contact name * First Name Last Name Contact number * (###) ### #### Union Affiliation Please enter the Local or Union Affiliation Number (if applicable) Classification Foreman Journeyman Apprentice Utility NOTE: We are a closed union shop; all field employees must join a designated union within 7 days of employment Field positions are located at our job sites across Western, WA and require employees ensure they can arrive at a specific worksite on time. Is there anything preventing you from meeting this job requirement? * Yes No If yes, please explain: Field positions are engaged in construction work including drywall, taping, and painting requiring highly physical work. Is there anything preventing you from meeting this job requirement? * Yes No If yes, please explain: DO YOU HAVE ANY OF THE FOLLOWING: if yes, please enter the expiration date where indicated Scaffold builder/User Card * Yes No Scaffold builder/User Card Expiration Date MM DD YYYY First Aid/CPR Card * Yes No First Aid/CPR Card Expiration Date MM DD YYYY Forklift: Rough/Terrain/Industrial * Yes No Forklift: Rough/Terrain/Industrial Expiration Date MM DD YYYY Welding Certificate: WABO/AWS * Yes No Welding Certificate: WABO/AWS Expiration Date MM DD YYYY HILTI Card * Yes No Aerial Lift * Yes No OSHA 10 or 30 * Yes No Drug Free Card * Yes No Fall Protection * Yes No Stilts Awareness * Yes No OTHER: Lead/Asbestos Awareness * Yes No Haz-Cert * Yes No C-Stop * Yes No Silica Awareness * Yes No Confined Space * Yes No Traffic Flagger * Yes No Traffic Flagger Expiration Date MM DD YYYY Other(s) not listed Military Veteran This question is for demographic purposes only Yes No I prefer not to disclose Military Veteran: Branch Military Veteran: Enlist Date MM DD YYYY Military Veteran: Discharge Date MM DD YYYY Military Veteran: Discharge Status Member: Military Reserve or National Guard This question is for demographic purposes only Yes No I prefer not to disclose Military Occupation Specialty (MOS): I hereby certify that all statements made in this application and accompanying materials are true and I agree and understand that any misstatement or omission of material fact will cause forfeiture on my part of all my rights of employment with Powerco Alliance Partition Systems. I hereby authorize Powerco Alliance Partition Systems to solicit information from my past employers as well as through a background check. I release parties from any claims of liability arising from such inquiry or investigation or the supplying of information for such an investigation. Finally, I acknowledge that my potential employment is at-will, which means that either the employee r the company is free to terminate the employment relationship at any time, with or without reason, advance notice, or warning. I have read and been informed about the content, requirements, and expectations of APS company policies. Signature * Print your full name Date * MM DD YYYY EMPLOYMENT / WORK HISTORY List all employers for the past three (3) years beginning with the most recent. #1 Current Employer Company Name Start Date MM DD YYYY End date MM DD YYYY Supervisor's Name Supervisor's Number * (###) ### #### Company Address Reason for Separation May we contact this organization? Yes No #2 Company Name Start Date MM DD YYYY End Date MM DD YYYY Supervisor's Name Supervisor's Number * (###) ### #### Company Address Reason for Separation May we contact this organization? Yes No #3 Company Name Start Date MM DD YYYY End Date MM DD YYYY Supervisor's Name Supervisor's Number * (###) ### #### Company Address Reason for Separation May we contact this organization? Yes No #4 Company Name Start Date MM DD YYYY End Date MM DD YYYY Supervisor's Name Company Address Reason for Separation May we contact this organization? Yes NO #5 Company Name Start Date MM DD YYYY End Date MM DD YYYY Supervisor's Name Company Address Reason for Separation May we contact this organization? Yes No Thank you!
