Employment Application Step 1 of 7 14% Applicant Name* First Middle Last Have you ever worked under another name?*YesNoAlternate Name* First Last Position DesiredSchedule Desired* Full Time Part Time When can you begin work?* Date Format: MM slash DD slash YYYY Applicant Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Have you lived at the above address for the past 3 years?*YesNoApplicant's Previous Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Primary Phone*Phone Type*CellHomeWorkAlternate PhoneAlternate Phone TypeCellHomeWorkEmail* Enter Email Confirm Email How did you learn about this job opportunity?* Union referral Newspaper ad Our website Career search website Rauhorn employee Other Name of newspaper*Website name*Name of Rauhorn Electric employee that referred you*Explain where you found this opportunity*Are you in a union?*YesNoWhat union are you in?*Do you have a valid driver's license?*YesNoDriver's License Number*Issuing State*AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces PacificExpiration Date* Date Format: MM slash DD slash YYYY Restrictions*License Type*Operator/DriverChaffeursCommercial**The Federal Motor Carrier Safety Regulations apply to anyone operating a motor vehicle on a highway in interstate commerce to transport passengers or property when the vehicles: (1) weighs or has a GVWR of 10,001 pounds or more, (2) is designed or used to transport more than 8 passengers (including the driver) for compensation; or (3) is designed or used to transport more than 15 passengers, including the driver, and is not used to transport passengers for compensation; or (4) is of any size and is used to transport hazardous materials in a quantity requiring placarding. Per the FMESA, applicants with a commercial drivers license are required to provide employers with additional information regarding experience and qualifications.SSN #*Date of Birth* Date Format: MM slash DD slash YYYY Section 383.21 FMCSR states: "No person who operates a commercial motor vehicle shall at any time have more than one driver's license."* I certify that I do not have more than one motor vehicle license. Have you ever been denied a license, permit, or privilege to operate a motor vehicle?*YesNoPlease explain*Has any license, permit, or privilege ever been suspended or revoked?*YesNoPlease explain*CDL Class*Class AClass BClass CEndorsement(s):* X H N T S P F None How long have you held your CDL?*Less than one yearOne or more yearsDriving ExperienceIf you have no driving experience within the last 3 years - check here No experience Class of Equipment*Straight TruckTractor & Semi-TrailerTractor - Two TrailersMotor Coach - School Bus (Greater than 8 passengers)Motor Coach - School Bus (Greater than 15 passengers)OtherType of Equipment*VanTankFlatBucket TruckDigger DerrickCrane TruckLow BoyN/AFrom Date Date Format: MM slash DD slash YYYY To Date Date Format: MM slash DD slash YYYY Approximate Number of MilesDo you want to add more driving experience?*YesNoClass of Equipment*Straight TruckTractor & Semi-TrailerTractor - Two TrailersTractor - Three TrailersMotor Coach - School Bus (Greater than 8 passengers)Motor Coach - School Bus (Greater than 15 passengers)OtherType of Equipment*VanReeferTankFlatN/AFrom Date Date Format: MM slash DD slash YYYY To Date Date Format: MM slash DD slash YYYY Approximate Number of MilesAccident History (3 Years)If you have no accidents within the last 3 years - check here No accidents Accident #1Date Date Format: MM slash DD slash YYYY Nature of Accident*Number of Fatalities*Number of Injuries*Hazardous Materials Spill?*YesNoDo you want to add more accident history?*YesNoAccident #2Date Date Format: MM slash DD slash YYYY Nature of Accident*Number of Fatalities*Number of Injuries*Hazardous Materials Spill?*YesNoTraffic Convictions and Forfeitures (3 Years)If you have no traffic convictions and/or forfeitures within the last 3 years - check here No convictions and/or forfeitures Date Convicted Date Format: MM slash DD slash YYYY Violation*State of Violation*AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces PacificPenalty*Do you have reliable transportation to and from work?*YesNoHave you ever worked for Rauhorn Electric before?*YesNoFrom Date* Date Format: MM slash DD slash YYYY To Date* Date Format: MM slash DD slash YYYY Previous Position*Are you legally eligible to work in the United States?*YesNoAre you able to perform the essential functions of the job for which you are applying, with or without accommodation(s)?*YesNo Criminal InformationNote: Answering “yes” to these questions does not constitute an automatic bar to employment. Factors such as the applicant’s age and year of the offense, seriousness and nature of the violation, and rehabilitation will be taken into account. Do not include minor traffic citations and arrests or convictions which have been sealed or expunged.Have you ever had your license revoked or suspended?*YesNoPlease explain*Have you ever pled guilty, or no contest to, or been convicted of a felony?*YesNoPlease explain*Have you ever tested positive or refused to comply with a pre-employment, post-accident, random, or reasonable suspicion drug or alcohol test for any employer for which you have worked in the past 3 years?*YesNoPlease explain* Education and Training InformationHighest Education Completed*Elementary or middle schoolSome high school, no diplomaHigh school graduate, diploma or the equivalent (eg. GED)Some college credit, no degreeTrade/technical/vocational trainingAssociate degreeBachelor's degreeMaster's degree or higherAre you currently in school?*YesNoSchool Details*Would you like to add details about another school?*YesNoAdditional School Details*Please list any licenses, certifications, awards, or trainings you currently hold:Have you had any experience in the Armed Forces of the United States or in a State National Guard?*YesNoBranchCurrent rank or rank at dischargeDate of Discharge Date Format: MM slash DD slash YYYY Are you currently in the reserves?*YesNoDate obligation ends Date Format: MM slash DD slash YYYY Employment HistoryPlease use the Employer spaces below or upload your resume to provide at least 3 years of employment history.Have you ever been terminated or asked to resign from any job, or involuntarily discharged from a position?*YesNoPlease explain*Upload ResumeEmployer 1Employer NameLocationWere you subject to the Federal Motor Carrier Safety Regulations while employed?YesNoWas your job designated as a safety-sensitive position and subject to the drug and alcohol testing requirements of 49 CFR Part 40?YesNoPosition HeldEmployed From Date Format: MM slash DD slash YYYY Employed To Date Format: MM slash DD slash YYYY Supervisor Name First Last Reason for SeparationWould you like to add more employment history?YesNoEmployer 2Employer NameLocationWere you subject to the Federal Motor Carrier Safety Regulations while employed?YesNoWas your job designated as a safety-sensitive position and subject to the drug and alcohol testing requirements of 49 CFR Part 40?YesNoPosition HeldEmployed From Date Format: MM slash DD slash YYYY Employed To Date Format: MM slash DD slash YYYY Supervisor Name First Last Reason for SeparationWould you like to add more employment history?YesNoEmployer 3Employer NameLocationWere you subject to the Federal Motor Carrier Safety Regulations while employed?YesNoWas your job designated as a safety-sensitive position and subject to the drug and alcohol testing requirements of 49 CFR Part 40?YesNoPosition HeldEmployed From Date Format: MM slash DD slash YYYY Employed To Date Format: MM slash DD slash YYYY Supervisor Name First Last Reason for SeparationDid you have any gaps in employment?*YesNoDate From* Date Format: MM slash DD slash YYYY Date To* Date Format: MM slash DD slash YYYY Please Explain*Any additional experience, training, or qualifications Voluntary Self-Identification FormRauhorn Electric, Inc. ("Rauhorn") is an equal opportunity employer. As a government contractor subject to Executive Order 11246 and the Vietnam Era Veterans' Readjustment Assistance Act (VEVRAA), Rauhorn is required to submit reports to the U.S. Department of Labor and Equal Employment Opportunity Commission each year identifying the number of our employees belonging to each specified protected veteran category, gender and race/ethnicity category. Submission of this information is voluntary, and refusal to provide it will not subject you to any adverse treatment. The information provided will be kept confidential, maintained separate from other personnel records and only accessed by the human resource department. Please return completed forms to the HR department. Gender(Please select one of the options below)MaleFemaleEthnicity(Please check one of the descriptions below corresponding to the ethnic group with which you identify.) Hispanic or 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, the Middle East or North Africa. Black or African American (Not Hispanic or Latino): A person having origins in any of the black racial groups of Africa. Native Hawaiian or 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 Alaska 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 attachment. Two or more races (Not Hispanic or Latino): All persons who identify with more than one of the above five races. I do do not wish to disclose I belong to the following classifications of protected veterans (choose all that pply) Disabled Veteran: A "disabled veteran" is one of the following: 1) 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 2) A person who was discharged or released from active duty because of a service-connected disability. Recently Separated Veteran: A "recently separated veteran" means any veteran during the three-year period beginning on the date of such veteran's discharge or release from active duty in the U.S. military, ground, naval or air service. Active Wartime or Campaign Badge Veteran: 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. Armed Forces Service Medal Veteran: 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 U.S. military operation for which an Armed Forces service medal was awarded pursuant to Executive Order 12985. I am a protected veteran, but I choose not to self-identify the classifications to which I belong I am NOT a protected veteran If you are a disabled veteran, please indicate whether there are accommodations we could provide that would enable you to perform the essential functions of your 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. The information you submit will be kept confidential, except that (i) supervisors and managers may be informed about the restrictions on the work or duties of disabled veterans and about 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. Voluntary Self-Identification of DisabilityWhy 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. Disabilities include but are not limited to: Blindness Autism Deafness Cerebral palsy Cancer HIV/AIDS Diabetes Schizophrenia Epilepsy Muscular 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 following 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 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 equal employment obligations of Federal contractors, visit the U.S. Department of Labor's Office of Federal Contract Compliance Programs (OFCCP) website at 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 0MB control number. This survey should take about 5 minutes to complete. APPLICANT CERTIFICATION AND AT-WILL STATEMENT(Applicant must read the following and acknowledge by signing below.) Under Michigan law only, employers must make accommodations to disabled applicants and employees where the employee makes their need known to the employer, requests accommodation and such accommodation does not impose an undue hardship on the employer. Under Michigan law only, disabled applicants and employees may request an accommodation of their disability by notifying the firm in writing of the need for accommodation within 182 days of the date the disabled individual knows or should know that an accommodation is needed. This requirement does not apply to an individual's rights under the Americans with Disabilities Act. Failure to properly notify the firm may preclude any claim that the employer failed to accommodate the disabled individual. Upon the signing of this application, I certify that I have read and understood all of this employment application and that all of the information now or hereafter given by me in support of my application is true and complete. It is agreed and understood that the employer and his agents may investigate my background to ascertain any and all information of concern to my employment history, whether same is of record or not. I authorize the employer to verify any information concerning my background, including but not limited to employment, education, credit history, driving record, education, criminal history, or medical history (post-offer only), with the appropriate individuals, companies, institutions or agencies, and I authorize them to release such information as you require, including my prior disciplinary employment record without any obligation to give me written notice of such disclosure. I also authorize you to release any information (including medical information) requested by any of my prospective or subsequent employers without any obligation to give me written notice of such disclosure. I hereby release you and them from any liability whatsoever as a result of any such inquiries and disclosures, and this release from liability, except as prohibited by law, does not waive or prohibit an individual from filing a charge of discrimination under the laws enforced by the EEOC. I agree that any false or incomplete information that causes my application to be misleading may subject me to discharge at any time during the period of my employment. I also understand that an offer of employment extended by you may be contingent upon the results of a physical examination and drug test satisfactory to the employer in its sole discretion and upon my acceptance of such offer of employment I authorize and consent to such examination and drug test. I understand that the results of such examination and drug test shall be maintained on separate medical forms and in medical files and that such confidential information shall only be disclosed to managers, supervisors, first aid and/or safety personnel regarding necessary restrictions or accommodations with respect to assigned work or for safety and/or medical purposes or to human resources department or the company's legal representatives as required in the ordinary course of business. I agree that my employment, if hired by Rauhorn Electric, Inc. and/or it's related entities, is "at-will" and either party may terminate the employment relationship, with or without cause, at any time, and I further agree that this arrangement may only be altered in writing directed to me personally and signed by the president of this company. I agree that I shall be bound by the other rules, policies, regulations and terms and conditions of employment of the firm as they are from time to time changed, and no additional obligations can be imposed on the company except which have been acknowledged in writing, by the president or his designated representatives. I agree that any action (excluding governmental, statutory administrative proceedings) or suit against the company and its agents or employees, arising out of my employment or termination, including but not limited to, claims arising under State and Federal Law, but not Federal civil rights statutes containing a separate limitations period, must be brought within 180 days of the event giving rise to the claim or the applicable statute of limitations, or be forever barred unless the applicable statues of limitations period is shorter than 180 days in which case I will continue to be bound by the shorter limitations period. I waive any limitation periods to the contrary with the exception being that this agreed to limitations period does not supersede the Federal Equal Employment. Opportunity Commission or other applicable statutes or regulations that may extend this period as provided by law. I further agree that if I should bring any non-statutory action or claim arising out of my employment against the company, in which the company prevails, I will pay to the company any and all such costs incurred by the firm in defense of said claims or actions, including attorney fees. I acknowledge that this Arbitration Policy and 180 day limitation on actions form an Agreement between myself and Rauhorn Electric, Inc. I agree to furnish such additional information and complete such examinations as may be required to complete my employment file. I also understand that misrepresentation or omission of information or facts may results in my rejection or dismissal. This certifies that this application was completed by me, and that all entries on it and information in it are true and complete to the best of my knowledge.Electronic Signature* First Middle Last I agree* Yes This iframe contains the logic required to handle Ajax powered Gravity Forms.