APPLICATION SUBMITTAL INSTRUCTIONS All employment applications must be submitted to Garner’s corporate office listed below to the attention of the HR department either in person or by fax, by email or mail: Garner Environmental Services, Inc. 1717 West 13 th Street Deer Park, Tx 77536 ATTN: HR Department (281) 478-0814 fax [email protected]Applications accepted for available positions ONLY ********APPLICANT PRE-SCREEN QUESTIONNAIRE********* The attached questionnaire must be completed to determine your eligibility for employment per Garner Environmental policies **************************************************** Please make sure the application is completed in full Please make sure items requiring initials are initialed, not checked Please make sure application is signed and dated Please DO NOT include copies of ID or certifications Incomplete applications will not be considered Rev 11.15.14
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Applications accepted for available positions ONLY
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APPLICATION SUBMITTAL INSTRUCTIONS
All employment applications must be submitted to Garner’s corporate office listed below to the attention of the HR department either in person or by fax, by
email or mail:
Garner Environmental Services, Inc. 1717 West 13th Street Deer Park, Tx 77536
Garner Environmental Services, Inc. is an Equal Opportunity / Affirmative Action Employer
APPLICANT MUST MEET THE FOLLOWING CRITERIA SET BY OUR INSURANCE CARRIER IN ORDER TO DRIVE A COMPANY VEHICLE:
(If applicant checks “No” to any of the following questions, applicant is not eligible for hire) Yes ____ No ____ Is Applicant a minimum Age of 21 years?
Yes ____ No ____ Does Applicant have a valid driver’s license (not suspended)?
Yes ____ No ____ Does Applicant have an acceptable driving record?
An “acceptable driving record” as defined by our insurance carrier criteria includes no violations for DWI, DUI, OWI, OUT, refusing substance test, reckless driving, manslaughter, hit &run, eluding a police office, any felony, drag racing, license suspension, driving while license suspended, etc., for the previous 5 years. It also includes no more than one moving violation, which includes all vehicle accidents, speeding, improper lane change, failure to yield, running red lights or stop lights, etc., in the previous 3 years.
APPLICANT MUST SUCCESSFULLY PASS AN EXTENSIVE BACKGROUND CHECK PER OUR DISA BACKGROUND CRITERIA IN ORDER TO ENTER MOST PLANTS AND FACILITIES WE SERVICE:
(If applicant checks “Yes” to any of the following questions, applicant is not eligible for hire) Yes ____ No ____ Does Applicant have a felony conviction or felony conviction disposition in the past 7
years? Yes ____ No ____ Does Applicant have a misdemeanor conviction or misdemeanor conviction disposition
involving violence in the past 7 years? Yes ____ No ____ Does Applicant have a misdemeanor conviction or misdemeanor conviction disposition
involving moral turpitude (dishonesty, fraud, theft, etc.) in the past 7 years? DISA scores each background according to the criteria provided by plant and facilities we service. A “Yes” answer to any of the above would prevent entry into most of these plants and facilities.
APPLICANT IS REQUIRED TO SUCCESSFULLY PASS A PRE-EMPLOYMENT PHYSICAL AND DRUG SCREEN PER COMPANY POLICY:
Applicant will have to successfully pass a pre-employment physical and drug screen which includes hair follicle testing.
GARNER ENVIRONMENTAL POSITIONS REQUIRES A MINIMUM OF 50% TRAVEL (If applicant checks “No” to the following question, applicant is not eligible for hire)
Yes ____ No ____ Is Applicant willing to travel a minimum of 50%?
_______________________________________ __________________ Applicant Name - Signature Date
_______________________________________ Applicant Name - Printed
EQUAL OPPORTUNITY / AFFIRMATIVE ACTION EMPLOYER
Note: Applications will only be considered for 30 days from date above.
All questions must be answered completely or Applications will be not be considered.
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APPLICATION FOR EMPLOYMENT
P
E
R
S
O
N
A
L
Last Name First Name Middle Name Date
Street Address Home Telephone
( )
City, State, Zip Cell Phone
( )
Have you ever applied for employment with us?
Yes No If Yes: Month and Year ________Location_____________
Social Security #
Position Desired Pay Expected
$
Apart from absence for religious observance, are you available for full-time work?
Yes No If not, what hours can you work? _________________________
Will you work overtime if asked?
Yes No
Are you legally eligible for employment in the United States? Yes No When will you be available to
begin work? _______________
Other special training or skills (languages, machine operations, etc.) Please list all training and certifications and name as it
appears on driver license. ____________________________________________________________________________.
Please list driver license number: _______________________________ State: ____________ If CDL, type: _________.
Have you ever had a driver license with another number? Yes No If so, what number(s)? ___________________
Have you ever had a driver license in another state? Yes No If so, list all states and number(s)? _______________.
E
D
U
C
A
T
I
O
N
School
Name and Location of School
Course of
Study
No. Of
Years
Completed
Did You
Graduate?
Degree or
Diploma
Graduate
Yes
No
College
Yes
No
Business/Trade/Technical
Yes
No
High School
Yes
No
Elementary
Yes
No
Membership in Professional or Civic Organizations
(Exclude those which disclose your race, color, religion or national origin)
Prospective employees will
receive consideration without
discrimination because of race, creed, color, sex, age, national
origin, handicap or veteran
status.
EQUAL OPPORTUNITY / AFFIRMATIVE ACTION EMPLOYER
Note: Applications will only be considered for 30 days from date above.
All questions must be answered completely or Applications will be not be considered.
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EMPLOYMENT Please give accurate, complete full-time and
part-time employment record. Start with your
present or most recent employer.
1
Company Name Telephone
( )
Address Employed – (State month and year)
From To
Name of Supervisor Weekly pay
Start Last
State Job Title and Describe Your Work Reason for Leaving
2
Company Name Telephone
( ) Address Employed – (State month and year)
From To
Name of Supervisor Weekly pay
Start Last
State Job Title and Describe Your Work Reason for Leaving
3
Company Name Telephone
( ) Address Employed – (State month and year)
From To
Name of Supervisor Weekly pay
Start Last
State Job Title and Describe Your Work Reason for Leaving
4
Company Name Telephone
( ) Address Employed – (State month and year)
From To
Name of Supervisor Weekly pay
Start Last
State Job Title and Describe Your Work Reason for Leaving
In connection with and for the duration of my employment, if hired, I understand that Garner Environmental Services, Inc. (GESI) may obtain “consumer reports” and/or investigative consumer reports” for employment purposes that relate to my credit, criminal, driving, employment, or education history. This information will, in whole or in part, be obtained from DISA, Inc. Background Screening Services (DISA), 12600 Northborough Drive, Suite 300, Houston, Texas 77067, telephone 281-673-2449. These reports may include information as to my general reputation, character, personal characteristics, work habits, job performance, and experience, along with reasons for termination of past employment from previous employers. I understand that GESI will be requesting this information from various federal, state, county and other agencies or institutions, which maintain public and non-public records concerning my past activities relating to my driving, credit, civil, education, and other experiences. I further understand that I have the right to request, in writing, the nature and scope of any investigative consumer report and a Summary of Consumer Rights as prescribed by Section 606 of the Fair Credit Reporting Act. I acknowledge that, if a job offer is made, that the above “consumer reports” and/or “investigative consumer reports” may be obtained. I will submit the applicable consent forms provided by GESI in order to obtain the above mentioned information. __________________________________________________ Applicant Name – Printed __________________________________________________ Applicant Name – Signature _____________________________ Date
INVITATION TO SELF-IDENTIFY FOR PURPOSES OF EEOC & AFFIRMATIVE ACTION REPORTING Due to participation in government contracts, Garner Env is subject to certain governmental recordkeeping and reporting requirements. In order to comply with these laws, the company invites employees to voluntarily self-identify their race/ethnicity and gender status. Submission of this information is voluntary and refusal to provide it will not subject you to any adverse treatment. The information obtained will be kept confidential and may only be used in accordance with the provisions of applicable laws, executive orders, and regulations, including those that require the information to be summarized and reported to the federal government. When reported, data will not identify any specific individual. Please Check One: ____ Male ____ Female Please Check One: ____ 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 ____ Hispanic or Latino: a person of Cuban, Mexican, Chicano, Puerto Rica, South or Central
American or other Spanish culture or origin, regardless of race ____ Native Hawaiian or Other Pacific Islander (not Hispanic or Latino): a person having
origins in any of the original 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
____ American Indian or Alaska Native (not Hispanic or Latino): a person having origins in any of the original peoples of North and South America, including South Central America, and who maintains tribal affiliation or community attachment
____ Two or More Races (not Hispanic or Latino) ____ Check here if you do not wish to participate Applicant Name (printed): ______________________________________________________ Applicant Signature: __________________________________________ Date: ___________
Page 1 of 2
Invitation to Self-Identify for Protected Veterans As an EEO/AA employer, GESI, Inc. is subject to the Vietnam Era Veterans’ Readjustment Assistance Act of 1974 (VEVRAA) which requires government contractors to take affirmative action to employ and advance veterans in employment. VEVRAA prohibits discrimination and requires affirmative action in all personnel practices regarding protected veterans. The statute covers disabled veterans, Armed Forces service medal veterans, recently separated veterans, and other veterans who served during a war, or in campaign or expedition for which a campaign badge has been authorized.
Please check all that apply:
_____ Disabled Veteran
_____ Special Disabled Veteran
_____ Veteran of the Vietnam era
_____Other Protected Veteran
_____ Armed Forces Service Medal Veteran
_____ Other Veteran
_____ Not a Veteran
_____ I do not wish to participate
Employee Name (printed): _________________________________ Date: __________________ Employee Signature: ___________________________________________________________ VETERAN CATEGORY DEFINITIONS: Disabled Veteran: 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. Special Disabled Veteran: 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 Department of Veterans' Affairs for a disability (A) rated at 30 percent or more, or (B) rated at 10 or 20 percent in the case of a veteran who has been determined under Section 38 U.S.C. 3106 to have a serious employment handicap or (ii) a person who was discharged or released from active duty because of a service connected disability. Veteran of the Vietnam era: a person who: served on active duty in the U.S. military, ground, naval or air service for a period of more than 180 days, and who was discharged or released there from with other than a dishonorable discharge, if any part of such active duty was performed: (A) in the Republic of Vietnam between February 28, 1961, and May 7, 1975; or (B) between August 5, 1964, and May 7, 1975, in all other cases; or was discharged or released from active duty in the U.S. military, ground, naval or air service for a service connected disability if any part of such active duty was performed (A) in the Republic of Vietnam between February 28, 1961, and May 7, 1975; or (B) between August 5, 1964, and May 7, 1975, in any other location.
Page 2 of 2
VETERAN CATEGORY DEFINITIONS: - continued Other Protected Veteran: veterans 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. For those with Internet access, the information required to make this determination is available at http://www.opm.gov/veterans/html/vgmedal2.htm. Armed Forces Service Medal Veteran: 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 (61 Fed. Reg. 1209) at http://www.opm.gov/veterans/html/vgmedal2.asp. Other Veteran: a veteran of the U.S. military, ground, naval or air service that is not included in one of the categories listed above. You may inform us of your desire to benefit under the program at this time and/or at any time in the future. 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 Veterans' Readjustment Assistance Act of 1974, as amended. The information you submit will be kept confidential, except that (1) supervisors and managers may be informed regarding restrictions on the work or duties of disabled veterans, and regarding necessary accommodations; (2) 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 (3) Government officials engaged in enforcing laws administered by OFCCP, or enforcing the Americans with Disabilities Act, as amended, may be informed. It is the policy of Garner Environmental Services, Inc. [GESI] not to discriminate against any employee or applicant for employment because he or she is a protected veteran. A written copy of this Affirmative Action Program is available for inspection by any employee or applicant for employment, during normal business hours, in the Personnel Department. Interested persons should contact the Personnel Manager at 281.930.4439 for assistance. If you are a disabled veteran it would assist us if you tell us about (1) any special methods, skills, and procedures that qualify you for positions that you might not otherwise be able to do because of your disability so that you will be considered for any positions of that kind, and (2) any accommodations that we could make that would enable you to perform the job, including special equipment, changes in the physical layout of the job, elimination of certain duties relating to the job, provision of personal assistance services or other accommodations. This information will assist us in placing you in an appropriate position and in making accommodations for your disability.