Tapani Underground Application Form – Fill Out and Use This PDF

Tapani Underground, Inc..

PO Box 1900 – 1904 SE 6th Place

Battle Ground, WA 98604

(360) 687-1148 – Office

(360) 687-7968 – Fax

www.tapaniunderground.com

AN EQUAL OPPORTUNITY EMPLOYER

EMPLOYMENT APPLICATION

IMPORTANT, PLEASE READ THESE INSTRUCTION PRIOR TO COMPLETING YOUR APPLICATION: This application must be FULLY COMPLETED for consideration. Do not leave any question or information block unanswered. If you do not know an answer to a question, write UNKNOWN in the block. If a question does not apply to you, place an N/A in the answer block or set of blocks. You may attach a resume to this application, but resumes alone will not be considered for employment. DO NOT MARK THE APPLICATION “SEE RESUME”.

SECTION 1) APPLICANT INFORMATION:

2.Are you now or have you previously been employed by Tapani Underground, Inc.?

Yes No

Note: A conviction will not necessarily be a bar to employment. Each instance and explanation will be considered in relation to the position for which you are applying.

SECTION 2) EMPLOYMENT HISTORY:

2.Starting with your present employer, please account for your past work experience for the last 10 years. If applicable, please explain fully any gaps in your employment history in the sections provided. You may attach any supplemental information you think might be useful. However, be sure to fill out this section completely. You are responsible for ensuring that the information requested is accurate and complete.

Reason for leaving:

Nature of Work Performed and Job Responsibilities:

Reason for leaving:

Nature of Work Performed and Job Responsibilities:

SECTION 2) EMPLOYMENT HISTORY (continued)

Reason for leaving:

Nature of Work Performed and Job Responsibilities:

Reason for leaving:

Nature of Work Performed and Job Responsibilities:

SECTION 2) EMPLOYMENT HISTORY (continued):

Reason for leaving:

Nature of Work Performed and Job Responsibilities:

Reason for leaving:

Nature of Work Performed and Job Responsibilities:

If you need additional space for employment history of the last TEN years, please attach a separate sheet using the same format. Please ensure that each of the questions asked are answered in the same order.

SECTION 3) EDUCATION, TRAINING, CERTIFICATES & LICENSES

List all schools attended, except elementary and middle schools (DO NOT list from/to dates for High School):

Note: A valid driver’s license is required for positions where vehicle or equipment operation is an essential job duty.

List all valid drivers’ licenses (if yes), flagger certifications or other government issued licenses you currently have.

SPECIAL SKILLS / QUALIFICATIONS:

3.List any special skills or qualifications you may possess:

___________________________________________________________________________________

___________________________________________________________________________________

___________________________________________________________________________________

___________________________________________________________________________________

MACHINERY / EQUIPMENT OPERATING SKILLS

4.List any specialized machinery or equipment that you can operate. Please include any certification dates of formal training received:

____________________________________________________________________________________

____________________________________________________________________________________

____________________________________________________________________________________

____________________________________________________________________________________

DECLARATION AND CERTIFICATE OF UNDERSTANDING

&

PERMISSION TO OBTAIN INFORMATION

I understand that if I am employed, any misrepresentation or material omission made by me on this application will be sufficient cause for cancellation of this application or immediate discharge from the employer’s service, whenever it is discovered.

I give Tapani Underground, Inc., (hereinafter referred to as employer) the right to contact and obtain information from all references, current and former employers, and educational institutions and to otherwise verify the accuracy of the information contained in this application. I hereby release from liability the employer and other representatives from seeking, gathering and using such information and all other persons, corporations or organization for furnishing such information.

I understand that the employer does not unlawfully discriminate in employment and no questions on this application will be used for the purpose of limiting or excusing any application from consideration for employment on a basis prohibited by local, state or federal law.

I understand that this application is current for only 90 calendar days. At that time, if I have not heard from the employer and still wish to be considered for employment, I will be required to fill out a new application.

If I am hired, I understand that I am free to resign at any time, with or without cause and without prior notice, and the employer reserves the same right to terminate my employment at any time, with or without cause and without prior notice, except as may be required by law. This application does not constitute an agreement or contract for employment for any specified period or defined duration. I understand that no representative of the employer, other than an authorized officer, has the authority to make any assurances to the contrary. I further understand that such assurances must be in writing and signed by an authorized officer.

I understand it is this company’s policy not to refuse to hire a qualified individual with a disability because of that person’s need for a reasonable accommodation as required by the ADA. I also understand that if I need some form of accommodation to complete this application I am obligated to request that accommodation from the employer.

I also understand that if I am offered a position with employer, I will be required to provide proof of identity, legal work authorization, and pass a pre-employment drug test, and a non-discriminatory physical assessment screen as a condition precedent to my employment by employer.

I represent and warrant that I have read and fully understand the foregoing and seek employment under these conditions.

APPLICANT INFORMATION FORM

Our organization conducts some business with governmental agencies which requires that we report certain information, such as race/ethnic background of applicants. Qualified applicants are considered for employment, and employees are considered during employment, without regard to race, color, religion, sex, national origin, age marital status, medical condition, or disability.

Providing this information is voluntary, and refusal to provide it will not result in any adverse treatment. However, your completion of this form will assist us in complying with equal opportunity/affirmation action record keeping and reporting requirements. This information form will be kept in a separate, confidential file.

Position Applied For:______________________________________________________

Name:________________________________________________Date:_____________

Ra ce / Et h n ic Gr ou p ( se le ct on e on ly ) :

or igins in any of t he or iginal peoples of Nor t h and Sout h Am er ica ( including Cent r al Am er ica) , and w ho m aint ains t r ibal affiliat ion or com m unit y

at t achm ent .

□Tw o or Mor es Races – All per sons ( not Hispanic or Lat ino) w ho ident ify w it h m or e t han one of t he above five r aces.

Signat ur e: _____________ _______ ______ ___________ _____ Dat e: __ ________ __

I F YOU HAVE A DI SABI LI TY WHI CH WI LL I MPAI R YOU ABI LI TY TO PERFORM I N THE SELECTI ON PROCESS. YOU ARE RESPONSI BLE TO CONTACT THE HUMAN RESOURCES DEPARTMENT TO ARRANGE FOR REASONABLE ACCOMODATI ON. I F YOU FEEL YOU HAVE BEEN TREATED UNFAI RLY OR

DI SCRI MI NATED AGAI NST BECAUSE OF RACE, COLOR, NATI ONAL ORI GI N, SEX, AGE OR DI SABI LI TY. PLEASE CONTACT THE HUMAN RESOURCES DEPARTMENT.