Kenneth G. Myers Construction Co. Inc.

APPLICATION FOR EMPLOYMENT

An Equal Opportunity Employer

We do not discriminate on the basis of race, color, religion, national origin, sex, age, disability or any other protected status. All qualified applicants will be given equal opportunity and selection decisions will be based on job-related factors.

Answer each question fully and accurately. No action can be taken on this application until you have answered all relevant questions. Use blank paper if you do not have enough room on this application. PLEASE PRINT, except for signature on back of application. In reading and answering the following questions, be aware that none of the questions are intended to imply illegal preferences or discrimination based upon non-job-related information.

Personal

The type of employment you are currently seeking:

Please mark the shift(s) you are able to work:

Are you 18 years of age or older? (If you are hired, you may be required to submit proof of age.)

If hired, can you furnish proof you are eligible to work in the U.S.?

Have you ever applied here before?

Were you ever employed here?

Do you have relatives currently working here?

Have you ever been convicted of a felony? *

(A "Yes" answer does not automatically disqualify you from employment, since the nature of the offense, date, and the job for which you are applying is also considered.)

How were you referred to us?

If you are applying for a specific job for which a job description was provided, are you able to perform the stated essential job functions with or without reasonable accommodations?

Education

Name and Location of School or College Course or Major Did You Graduate? Years Attended Degree Obtained

Former Employers/Experience

Name and Address Position/Job Responsibilities Dates Employed Starting Salary Last Salary Reason for Leaving

Personal References (Not Relatives)

Name Adress Phone Business Know How Long?

Emergency Contact

Name Adress Phone

Special Skills

What skills, training, certification or licenses do you have that are related to the job for which you are applying?

Do you have a valid driver's license?

Driver's License Number

Class of License

Have you had your driver's license suspended or revoked in the last 3 years? If yes, give details:

List professional, trade, business, or civic activities and offices held. (Exclude labor organizations and memberships which reveal race, color, religion, national origin, sex, age, disability, or other protected status.)

What machines or equipment can you operate that are related to the job for which you are applying?

Are you now or do you expect to engage in any other business or employment?

If yes, please explain:

Kenneth G. Myers Construction Co., Inc

Employment Application

Employer: Kenneth G. Myers Construction Co., Inc.
Applicant:

PLEASE READ EACH STATEMENT CAREFULLY BEFORE SIGNING.

PLEASE INITIAL AT THE END OF EACH NUMBERED PARAGRAPH ON THE LINE PROVIDED
  1. I CERTIFY that the information provided on this application is true, accurate and complete to the best of my knowledge. I understand that incomplete, false or misleading information on this application or other employer records shall be grounds for denial of employment or immediate termination of employment, regardless of when or how It was discovered.
  2. I AUTHORIZE (i) Kenneth G. Myers Construction Co., Inc. to investigate information concerning the information I provided on this Application, including, but not limited to my previous education, employment, experience and character; (ii) those persons, schools and companies referenced above to freely provide information to Kenneth G. Myers Construction Co., Inc. for which I hereby release each of these persons and companies which provide or receive information about me from any and all liability for any damage that may result from furnishing such information; (iii) those persons, schools and companies referenced above to accept a photocopy or facsimile copy of this page as my consent and release of liability for providing all requested Information, including transcripts, to Kenneth G. Myers Construction Co., Inc.; and (iv) to request and receive a copy of my (a) criminal records, and (b) driving records.
  3. I AGREE, in consideration of my employment, to conform to all company rules and regulations and understand that these rules and regulations are subject to change from time to time at the employer's unilateral discretion.
  4. I UNDERSTAND that any offer of employment is contingent on my ability to provide proof that I am legally authorized to work in the United States.
  5. I UNDERSTAND that I do not have any expectation of privacy if employed and that all information and data, In any form, paper, electronic or otherwise, produced, possessed or reviewed at work is subject to review by the employer. Similarly, I understand that anything on company property is subject to search or surveillance, including, but not limited to my person, vehicle, work area, locker, desk and electronic files.
  6. I UNDERSTAND that all employer property must be returned and any indebtedness to the employer must be paid on or before my last day of work. I authorize the employer to deduct from my final paycheck an amount necessary to satisfy any unpaid obligation. Pursuant to federal law, the final paycheck must contain an amount equal to minimum wage times hours worked, plus overtime wages (if any).
  7. I UNDERSTAND as a final step in the hiring process, I may be subject to a post-offer, pre-employment, medical examination. If a job offer is made, it is contingent upon the success of this employment entrance medical examination. If this examination is required, I agree to sign all necessary consent forms.
  8. I UNDERSTAND and consent to any and all drug or alcohol testing which I may be subjected to by the employer, whether it is pre-offer, post-offer but pre-employment or at any time during my employment if I am hired. This testing may be random, mandatory, incident specific or based on the employer's reasonable suspicion. I further understand that my participation in the employer's drug testing program, which includes me signing alt necessary consent forms, is a mandatory condition of my employment and that refusal to participate may subject me to discipline, up to and Including termination of employment.
  9. I UNDERSTAND that the employer may request an investigative consumer report from a consumer reporting agency. If such a report is sought, I agree to sign a separate consent form in compliance with the Fair Credit Reporting Act, 15 U.S.C. ยง 1681-1681 u. This report may include information as to my character, reputation, personal characteristics, and mode of living obtained from interviews with neighbors, friends, former employers, schools, and others. I understand that I have a right to make a written request within a reasonable time for the disclosure of the name and address of the consumer reporting agency so that I may obtain a complete disclosure of the nature and scope of the investigation.
  10. I AGREE that any claim or lawsuit relating to my service with the employer must be filed no more than 6 months after the date of the employment act that is the subject of the claim or lawsuit. I waive any statute of limitations to the contrary.
  11. I UNDERSTAND and agree that my employment and compensation is at the will of the employer and myself and thus it may be terminated at any time with or without prior notice; with or without cause, at the option of the employer or myself, and I understand that no representative of the employer, other than Todd E. Myers, the President, has authority to enter into any agreement contrary to the foregoing. I further understand that any agreement contrary to the foregoing must be in writing and signed by myself and Todd E. Myers, the President to be effective.
  12. I UNDERSTAND that I may be required to have a Medical Examiner's certificate under Federal Motor Carrier Safety Regulations.

I have read, understand these statements.

Signature:
Date:
Printed Name:
Consistent with federal law, the employer wilt retain a copy of this application for record-keeping purposes for one year. However, this application for employment will not remain active after the position(s) applied for is/are filled.