Qualified applicants are considered for all positions without regard of race, color, sex, age, religion, national origin, veteran status, or the presence of any non-job related medical condition or disability, or any other characteristic protected by federal, state or local law.
PRE-EMPLOYMENT DRUG TESTING IS MANDATORY FOR ALL SAFETY SENSITIVE POSITIONS AND PER ACS DRUG TESTING POLICY
EDUCATION Did you graduate
Trade Skill Knowledge
Computer Knowledge Background
List your last three employers that you have been with for the past ten (10) years. Example If you have been employed with your last employer for 6 years and then one before that for 4 years, then list only those two employers. Start with the most recent. Include any military experience. Explain any gaps in employment in the comments section at the bottom of the page.
REFERENCES List name and telephone number of three business/work references who are not related to you and are not previous supervisors. If not applicable, then list three school or personal references that are not related to you.
If Yes, please provide dates of convictions and sentences (if any) on the back of this form. Note Any such conviction may be relevant if job related, but does not automatically bar you from employment.
The following Question does NOT need to be answered. It is your choice. Are you aware of any information that your feel would help us in considering your application? Examples of this might be certain talents and abilities you have, special projects you have been involved with, or personal accomplishments you have made; anything that would allow us to know you better than just answering the questions on the application. (use back of form for additional space)
Please read the following before signing your name at the bottom of the page.
APPLICANTS CERTIFICATION AND AGREEMENT
No supervisor, manager, or executive of Architectural Cast Stone has the authority to change the forgoing without prior written consent of the president of the company.
CONSENT FOR PRE-EMPLOYMENT, REASONABLE SUSPICION, AND POSTACCIDENT DRUG TEST SCREEN AND RELEASE COVENANT NOT TO SUE AND INDEMNITY AGREEMENT
I hereby CONSENT to allow Tyler Medical Services to take a specimen of my urine or blood and submit it for a pre-employment, reasonable suspicion, and post-accident drug test screening. I FURTHER CONSENT to allow the laboratory testing service to make the results of such screen available to the prospective or current employer, Architectural Cast Stone.
In consideration for such services being rendered on my behalf, I hereby RELEASE the laboratory testing service, its officers, agents, and employees, from any and all claims which I might otherwise have due to such results being made so available. I hereby CONSENT NOT TO FILE ANY ACTION at law or in equity against Architectural Cast Stone, the laboratory testing service, their respective officers, agents or employees in connection with the results of such screen being made so available, and I hereby agree to INDEMNIFY and SAVE HARMLESS Architectural Cast Stone, the laboratory testing service, their respective officers, agents, and employees from all damages, expenses, reasonable attorney's fees, and costs of court which they or any of them may suffer or incur, jointly or severally, due to the results of such screen being made so available.
PRE-EMPLOYMENT: Drug testing occurs after a conditional offer of employment has been extended to a candidate. Architectural Cast Stone reserves the right to withdraw offer if test yields a positive result.
D.O.T. REGULATION: Architectural Cast Stone administers drug testing to all drivers in accordance with the United States Department of Transportation drug and alcohol regulation 19 CRF 655.4.
POST-ACCIDENT: Drug testing is triggered by a work related incidents that involve: fatality; emergency medical care; or damage to vehicles or property above $500.00 threshold amount.
REASONABLE SUSPICION: Drug testing is conducted when a supervisor or manager have observed symptoms that give reason to believe or suspect an employee has engaged in the use of drugs or alcohol, or in the event that safety is a concern. Furthermore, Architectural Cast Stone reserves the right to protect the reputation of Architectural Cast Stone and its employees, and to reduce problems relating to carless, reckless, or unsatisfactory matters related to job performance for all positon company wide. Employees who are suspected of drug use may not return to work until Architectural Cast Stone has received the results of the reasonable suspicion testing.
SAFETY SENSITIVE: A job or position where an employee’s job function requires them to be responsible for his/her own safety or the safety of others. Positions that are safety sensitive would be considered dangerous if such an employee was using drugs or alcohol while on job. Examples include, but are not limited to; employees operating any equipment or employees who are around any equipment. Therefore, employees in safety sensitive position have to have clear mind and be diligent while occupying such positions.
Architectural Cast Stone is committed to maintaining a safe, drug-free working environment for it employees.
Any questions regarding this policy should be directed to our Human Resource Department.
Department of the Treasury Internal Revenue Service
(Rev. January 2012)
Jon applicant: Fill in the lines below and check any boxes that apply. Complete only this side.
*I am a member of a family that has received assistance from Temporary Assistance for Needy Families (TANF) for any 9 months during the past 18 months.
*I am a veteran and a member of a family that received Supplemental Nutrition Assistance Program (SNAP) benefits ( food stamps) for at least a 3-month period during the past 15 months.
*I was referred here by a rehabllitation agenacy approved by the state, an employement network under the Ticket to work program, or the Department of Veterans Affairs.
*I am at least age 18 but age 40 or older and I am member of a family that: a Received SNAP benefits (food stamps) for the 6 months, or b Received SNAP benefits (food stamps) for at least 3 of the past 5 months, but is no longer eligible to receive them.
*During the past year, I was convicted of a felony or released from prison for a felony.
*I received supplemental security income (SSI) benefits for any month ending during the past 60 days.
*I am a veteran and I was unemployed for a period or periods totaling at least 4 weeks but less than 6 months during the past year.
*Received TANF payments for at least the past 18 months, or
*Received TANF payments for any 18 months beginning after August 5, 1997, and the earliest 18-month period beginning after August 5, 1997, ended during the past 2 years, or
Stopped being eligible for TANF payments during the past 2 years because federal or state law limited the maximum time those payments could be made.
Under penalities of perjury, I declare that i gave the above information to the employer on or before the day I was offered a job, to the best of my knowledge , true, correct, complete.