AUSTIN GUTTERMAN, INC. APPLICATION FOR EMPLOYMENT An Equal Opportunity Employer 12229 Roxie Drive, Austin, Texas 78729 Phone (512) 450-1821IMPORTANT INFORMATION FOR APPLICANTS. PLEASE READ.1. Austin Gutterman, Inc. is an equal opportunity employer and selects employees solely on the basis of merit. It operates without reference to personal, social or political influence. No qualified person shall, on the basis of sex, race, religion, national origin, age, marital status, sexual orientation or disability, be subjected to discrimination. Selection is determined on the basis of job related experience, education, references and personal interviews.2. It is an unlawful employment practice for an employer to discriminate against any qualified disabled individual because of such individual's disability. If you need special accommodations made for you during the interview, or in the event you become employed by Austin Gutterman, Inc. and require accommodations in your work area, please alert Austin Gutterman management to your request for accommodation.ANSWER ALL QUESTIONS CAREFULLY.For what position are you applying?Type of Employment Desired (Check as many as apply) Full-time Part-time Temporary Days Evenings On what date are you available for work? MM slash DD slash YYYY Are you available to travel if required? Yes No Are you available to work weekends, holidays, and/or overtime? Yes No Your Name: First Middle Last Address: Street Address City State / Province / Region ZIP / Postal Code Home Phone Number:Cell Phone Number:Email: Do you have a valid driver's license? (if required for position you are seeking) Yes No License NumberState Where IssuedList other names under which you have worked or gone to schoolAre you legally eligible to work in the United States?* Yes No *If you are offered a position by Austin Gutterman, Inc., you will be required to provide proof of your eligibility to work in the United States.If yes, what documents indicate your eligibility?Have you ever pleaded guilty, been convicted, or placed on deferred adjudication for any felony, theft-related incident, or crime of moral turpitude in the past 7 years that may appear on a criminal background check? Yes No If yes, please explain here:Note: Due to the Federal Negligent Hiring laws passed in 2003, our company is required to perform a background check on all applicants being considered for employment, and is prevented from hiring an applicant with a criminal record. The nature of the offense, the date of the offense, the surrounding circumstances, and the relevance of the offense to the position for which you are applying may, however, be considered.Have you ever worked at Austin Gutterman, Inc.? Yes No If yes, what was your Position Title?Start Date: Month Day Year End Date: Month Day Year How did you hear about us? Referred by an individual Craigslist Monster.com Austin American-Statesman Our website Other If referred, what is the individual's name?Do you have relatives who work for Austin Gutterman, Inc.? Yes No If yes:NamePosition Title ReferencesList names, addresses, phone numbers and relationships of three persons not related to you who know your qualifications:Name:Address:Phone:Relationship: EducationName of High SchoolLocationDate of GraduationIf you did not graduate, please indicate the highest grade completed:Year CompletedIf you did not graduate, do you have a high school equivalency diploma? Yes No Date Received:School/Location:Course of Study:Dates Attended: List any degrees you have obtained:SkillsPlease list any foreign language skills you have:Are you skilled in the use of any computers or software? Please list:Do you have any experience, training, or special skills that you feel make you especially suited for work at Austin Gutterman? If so, please explain in detail:Employment HistoryList jobs held. Start with your present or last job.Employer:Supervisor: First Last Phone:Address: Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Position Title:Employment Type: Full-Time Part-Time # of Hours per Week:Start Date: MM slash DD slash YYYY End Date: MM slash DD slash YYYY Starting Rate of Pay:Ending Rate of Pay:May we contact your supervisor? Yes No Duties:Employer:Supervisor: First Last Phone:Address: Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Position Title:Employment Type: Full-Time Part-Time # of Hours per Week:Start Date: MM slash DD slash YYYY End Date: MM slash DD slash YYYY Starting Rate of Pay:Ending Rate of Pay:May we contact your supervisor? Yes No Duties:Employer:Supervisor: First Last Phone:Address: Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Position Title:Employment Type: Full-Time Part-Time # of Hours per Week:Start Date: MM slash DD slash YYYY End Date: MM slash DD slash YYYY Starting Rate of Pay:Ending Rate of Pay:May we contact your supervisor? Yes No Duties:Employer:Supervisor: First Last Phone:Address: Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Position Title:Employment Type: Full-Time Part-Time # of Hours per Week:Start Date: MM slash DD slash YYYY End Date: MM slash DD slash YYYY Starting Rate of Pay:Ending Rate of Pay:May we contact your supervisor? Yes No Duties:Employer:Supervisor: First Last Phone:Address: Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Position Title:Employment Type: Full-Time Part-Time # of Hours per Week:Start Date: MM slash DD slash YYYY End Date: MM slash DD slash YYYY Starting Rate of Pay:Ending Rate of Pay:May we contact your supervisor? Yes No Duties:PLEASE READ AND INITIAL EACH PARAGRAPH BELOW. IF THERE IS ANY PART OF THIS PAGE THAT YOU DO NOT UNDERSTAND, PLEASE ASK THE INTERVIEWER ABOUT IT BEFORE SIGNING. I hereby authorize Austin Gutterman, Inc. to thoroughly investigate my references, work records, education, and other matters related to my suitability for employment and, further, authorize my current and former employers to disclose to the company any and all letters, reports and other information pertaining to my employment with them, without giving me prior notice of such disclosure. In addition, I hereby release Austin Gutterman, Inc., my current and former employers, and all other persons, corporations, partnerships and associations from any and all claims, demands or liabilities arising out of or in any way related to such investigation or disclosure. I understand that if offered employment, the offer may be contingent upon my passing a pre-employment alcohol and drug screen test, as well as passing a pre-employment background investigation. By signing this application, I voluntarily agree to submit to both the alcohol/drug screen and background investigation, and understand that failure to pass either test will result in the withdrawal of any employment offer. If hired, I also agree to submit to random alcohol or drug testing as a condition of continued employment. I agree that Austin Gutterman, Inc. may conduct random alcohol or drug testing at its sole discretion with or without prior notice. I also understand that refusal to submit to such random testing will be considered a voluntary resignation of my employment. I also agree to abide by all company policies and procedures. I understand that nothing contained in this application or conveyed to me during any interview that may be granted is intended to create an employment contract, implied or explicit, between me and Austin Gutterman, Inc. In addition, I understand and agree that if I am employed, my employment relationship with Austin Gutterman, Inc. is strictly voluntary and at our mutual will. I understand that if employed, my employment is for no definite period and may be concluded at any time, with or without prior notice, with or without cause or reason, at the option of either myself or Austin Gutterman, Inc., and that no promises or representations contrary to the foregoing are binding on Austin Gutterman, Inc. unless made in writing and signed jointly by the company President and myself. I understand and agree that any future changes in my title, duties, compensation, working conditions, and/or Austin Gutterman, Inc.’s benefits, policies or procedures will not alter our at-will and arbitration agreements. I understand that if offered employment I will, as a condition of employment, be required to submit on the first day of my employment, proof of my identity and legal right to work in the United States. If the position for which I am applying requires driving in the course of work, I understand that I will be required to possess a current and valid Texas driver’s license and understand that I will be required to provide a copy of my official driving record and proof of insurance. I also understand that any offer of employment is contingent upon my ability to be covered under Austin Gutterman, Inc.’s auto insurance policy, if required for my position. If the position for which I am applying requires me to participate in skills testing specific to the gutter industry including, but not limited to, ladder tests, rope tests, machining, cutting, roof climbing, warehousing, or any other tests used to determine specific gutter industry skills, I hereby release, waive, discharge and covenant not to sue Austin Gutterman, Inc., its owners, officers, and employees, from liability from any and all claims, including the negligence of Austin Gutterman, Inc., its owners, officers, and employees, resulting in personal injury, accidents, or illness (including death) and property loss arising from but not limited to participation in the aforementioned testing situations. I hereby certify that I have not knowingly withheld any information that might adversely affect my chances for employment and that the answers given by me are true and correct to the best of my knowledge. I further certify that I, the undersigned applicant, have personally completed this application. I understand that any omission or misstatement on this application or on any documents used to secure employment shall be grounds for rejection of this application or for immediate discharge if I am employed, regardless of the time elapsed before discovery. I confirm that I am not currently bound by any restrictive covenants or non-compete agreements. My signature below certifies that I have read and understand this complete page, and agree to the terms and conditions outlined in this document.Applicant's SignatureDateCAPTCHA Δ
