A & A Wind Pro Job Application

Applicant Information

Job Applicant Name *

First NameLast Name

Job Applicant Current Address *

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Number of Years at this Address? *

Daytime Phone Number *

Area CodePhone Number

Evening Phone Number *

Area CodePhone Number

Mobile Phone Number *

Area CodePhone Number

Email Address *

example@example.com

Drivers License (State/Number)

Drivers License Expiration Date

Who should be contacted if you are involved in an Emergency? *

Relationship to you *

Address *

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Daytime Phone Number *

Area CodePhone Number

Evening Phone Number *

Area CodePhone Number

Job Position Applied For *

Crew Member

Who referred you to the company? *

Do you have friends or relatives who work here? If so please list here.

Have you applied to our company previously? *

YesNo

If Yes, when?

Are you at least 18 years old? *

YesNo

How will you get to work? *

Are you willing to work any shift, including nights and weekends? *

YesNo

If no, please state any limitations:

If applicable, are you available to work overtime? *

YesNo

If you are offered employment, when would you be available to begin work? *

If hired, are you able to submit proof that you are legally eligible for employment in the United States? *

YesNo

Are you able to perform the essential functions of the job position you seek with or without reasonable accommodation? *

YesNo

What reasonable accommodation, if any, would you request?

Have you ever been convicted of a felony or misdemeanor? *

YesNo

If Yes, Please list Offense, Date, City and State

THE EXISTENCE OF A CRIMINAL RECORD DOES NOT CONSTITUTE AN AUTOMATIC BAR TO EMPLOYMENT UNLESS RELEVANT TO THE TYPE OF EMPLOYMENT.

Job Applicant nature and extent of experience of operation motor vehicles, including equipment type (such as buses, trucks, semitrailers, truck tractors, full trailers, or pole trailers)

Job Applicant's list of all motor vehicle accidents in which applicant was involved in during the 3 years preceding the application date

Job Applicant's list of all violations of motor vehicle laws or ordinances (excluding violations involving only parking) in which applicant was convicted or forfeited bond or collateral in during the 3 years preceding the application date

Statement by Job Applicant setting forth in detail the facts and circumstances of any denial, revocation, or suspension of any license, permit or privilege to operate a motor vehicle that has been issued to the applicant, or a statement that no such denial, revocation, or suspension has occurred

Job Applicant's list of names and addresses of applicant's employers during the 3 years preceding the application date, the dates s/he was employed by that employer, reason(s) for leaving the employ of that employer, and whether the Applicant was subject to the FMCSRs while employed by that previous employer, and whether the job was designated as a safety sensitive function in any DOT regulated mode subject to alcohol and controlled substances testing requirements. **

Applicant Skill

Put the number of years of Experience next to skill then select your knowledge level for that skill.

OSHA 10 Hour Outreach (Years of Experience) *

OSHA 10 Hour Outreach (Skill Level) *

Confined Space Training (Years of Experience) *

Confined Space Training (Skill Level) *

Medic First Aid CPR with AED Certification (Years of Experience) *

Medic First Aid CPR with AED Certification (Skill Level) *

Tractel and Rollgliss Controlled Descent Certification (Years of Experience) *

Tractel and Rollgliss Controlled Descent Certification (Skill Level) *

NFPA 70E Arc Flash Safety Certification (Years of Experience) *

NFPA 70E Arc Flash Safety Certification (Skill Level) *

Lockout/Tagout (LOTO) (Years of Experience *

Lockout/Tagout (LOTO) (Skill Level) *

Fire Extinguishers Subparts E & L (Years of Experience) *

Fire Extinguishers Subparts E & L (Skill Level) *

Hazcom Subpart Z (Years of Experience) *

Hazcom Subpart Z (Skill Level) *

BBP Subpart Z (Years of Experience) *

BBP Subpart Z (Skill Level) *

Heat Stress (Years of Experience) *

Heat Stress (Skill Level) *

Ergonomics (Years of Experience) *

Ergonomics (Skill Level) *

Electrical Subpart S (Years of Experience) *

Electrical Subpart S (Skill Level) *

Walking Working Surfaces Subpart D (Years of Experience) *

Walking Working Surfaces Subpart D (Skill Level) *

PPE (Years of Experience) *

PPE (Skill Level) *

Avanti Lift Certification (Years of Experience) *

Avanti Lift Certification (Skill Level) *

40 Hr. Hazardous Waste Operation & Emergency Response (Years of Experience) *

40 Hr. Hazardous Waste Operation & Emergency Response (Skill Level) *

Applicant Employment History

List your current or most recent employment first. Please list all jobs (including self-employment and military service) which you have held, beginning with the most recent, and list and explain any gaps in employment. If additional space is needed, continue on the back page of this application.

Employer 1 Name *

Supervisor 1 Name *

Address *

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Job Duties *

Reason For Leaving *

Dates of Employment (Month/Year) *

Employer 2 Name *

Supervisor 2 Name *

Address *

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Job Duties *

Reason For Leaving *

Dates of Employment (Month/Year) *

Employer 3 Name *

Supervisor 3 Name *

Address *

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Job Duties *

Reason For Leaving *

Dates of Employment (Month/Year) *

Job Applicant's list of names and addresses of applicant's employers during the 7-year period preceding the 3 years preceding the application date, including the dates of employment and reasons for leaving such employment **

Applicants Education and Training

College/University Name and Address *

Did you receive a degree? *

YesNo

If yes, degree(s) received

High School/GED Name and Address *

Did you receive a degree? *

YesNo

If yes, degree(s) received

Other Training (graduate, technical, vocational):

Please indicate any current professional licenses or certifications that you hold

Awards, Honors, Special Achievements

Military Service

YesNo

Branch

Specialized Training

References

List any two non-relatives who would be willing to provide a reference for you.

Reference 1 Name *

Address *

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Phone Number *

Area CodePhone Number

Relationship *

Reference 2 Name *

Address *

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Phone Number *

Area CodePhone Number

Relationship *

Please provide any other information that you believe should be considered, including whether you are bound by any agreement with any current employer:

CERTIFICATION

I certify that the information provided on this application is truthful and accurate. I understand that providing false or misleading information will be the basis for rejection of my application, or if employment commences, immediate termination.

I authorize A & A Wind Pros, Inc. to contact former employers and educational organizations regarding my employment and education. I authorize my former employers and educational organizations to fully and freely communicate information regarding my previous employment, attendance, and grades. I authorize those persons designated as references to fully and freely communicate information regarding my previous employment and education.

If an employment relationship is created, I understand that unless I am offered a specific written contract of employment signed on behalf of the organization by its Owner, the employment relationship will be “at-will.” In other words, the relationship will be entirely voluntary in nature, and either I or my employer will be able to terminate the employment relationship at any time and without cause. With appropriate notice, I will have the full and complete discretion to end the employment relationship when I choose and for reasons of my choice. Similarly, my employer will have the right. Moreover, no agent, representative, or employee of A & A Wind Pros, Inc., except in a specific written contract of employment signed on behalf of the organization by its Owner, has the power to alter or vary the voluntary nature of the employment relationship.

I HAVE CAREFULLY READ THE ABOVE CERTIFICATION AND I UNDERSTAND AND AGREE TO ITS TERMS.

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.

Applicant Name *

Date

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At the completion of this application, I will initiate a text thread from the mobile phone number I can be reached at, including these 2 numbers: 405-226-2737, 580-313-0660

YesNo

**(1) The prospective employer must expressly notify drivers with Department of Transportation regulated employment during the preceding three years - via the application form or other written document prior to any hiring decision - that he or she has the following rights regarding the investigative information that will be provided to the prospective employer pursuant to paragraphs (d) and (e) of this section:

(i) The right to review information provided by previous employers;

(ii) The right to have errors in the information corrected by the previous employer and for that previous employer to re-send the corrected information to the prospective employer;

(iii) The right to have a rebuttal statement attached to the alleged erroneous information, if the previous employer and the driver cannot agree on the accuracy of the information.

(2) Drivers who have previous Department of Transportation regulated employment history in the preceding three years, and wish to review previous employer-provided investigative information must submit a written request to the prospective employer, which may be done at any time, including when applying, or as late as 30 days after being employed or being notified of denial of employment. The prospective employer must provide this information to the applicant within five (5) business days of receiving the written request. If the prospective employer has not yet received the requested information from the previous employer(s), then the five-business days deadline will begin when the prospective employer receives the requested safety performance history information. If the driver has not arranged to pick up or receive the requested records within thirty (30) days of the prospective employer making them available, the prospective motor carrier may consider the driver to have waived his/her request to review the records.

A & A Wind Pro Job Application

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