Employment Form Operations Manager

Middle Name

Last Name(required)

First Name(required)

Address(required)

City(required)

State(required)

Zip(required)

Home Phone(required)

Cell Phone

Email address(required)

Position Applying For(required)

Salary Desired(required)

Have you ever been employed with us before?(required)

Yes

If yes, Who was your supervisor?

Are you legally eligible to work in the U.S.?(required)

Yes

Do you now or will you in the future require visa sponsorship for employment at Kirkhill?(required)

Yes

Kirkhill, Inc. is proud to be a Federal contractor and supplier of material to the US Department of Defense. To conform with US export regulations and ITAR 120.15 and EAR Part 772, incumbents for this role should be eligible for any required authorizations from the US government. Are you eligible for required authorizations from the US Government to meet ITAR/EAR provisions? (required)

Yes

I don't know

Can you work nights?(required)

Yes

When could you start?(required)

If hired, are you willing to submit to and pass a controlled substance test?(required)

Yes

If no state reason.

Education

High School

Name of School

Type of School

No. of Years Completed

Major & Degree Obtained

College

Name of School

Type of School

No. of Years Completed

Major & Degree Obtained

Business or Trade School

Name of School

Type of School

No. of Years Completed

Major & Degree Obtained

Professional School

Name of School

Type of School

No. of Years Completed

Major & Degree Obtained

Military

Have you ever been in the armed forces?(required)

Yes

Date Entered

Specialty

Are you now a member of the National Guard?(required)

Yes

Discharged Date

Typical Physical Demand Requirements Include: Full range of body motion, normal range of vision, frequent bending and stooping, standing for long periods of time, lift up to 75 pounds on a regular basis.

Typical General Duty Requirements: Read a tape measurer, basic arithmetic, reading and writing, computer work, following directions from supervisor, learn job an

Are you able to perform the essential functions listed above for the job in which you are applying, either with or without reasonable accommodation?(required)

Yes

If NO, describe the functions that cannot be performed.

Please describe any additional information that may be helpful to us in considering your application.

Work Experience

Please list your 3 most recent jobs, beginning with the most recent job held.

1

Company

Job Title

Address

City

State

Zip

Phone

Employed From

Employed To

Still Employed?

Yes

Reason For Leaving

2

Company

Job Title

Address

City

State

Zip

Phone

Employed From

Employed To

Still Employed?

Yes

Reason for Leaving

3

Company

Job Title

Address

City

State

Zip

Phone

Employed From

Employed To

Still Employed?

Yes

Reason for Leaving

Attach A Resume

Maximum size 10MB

I understand the employment relationship is “at will” and may be terminated for any or no reason without prior notice by either party. I further understand this written statement supersedes any and all oral representations made by agents or representatives of this company. I certify that the information on this application, on related papers, and in interviews is true, correct and complete. I recognize that false, misleading or omitted information will result in discharge or refusal of employment. I authorize the employer to make inquiries concerning prior work experience. I release from liability all persons, companies and corporations supplying any such information. I have read and understand the above statements.

Signature(required)

Date

It is the policy of Kirkhill Inc. to recruit, hire, train, and promote employees without discriminating based on race, sex, sexual orientation, gender identity, age, religion, national origin, veteran status or disability. Kirkhill recognizes that the effective application of such a policy of merit employment involves more than just a statement. We therefore train and advise those who are in a position to make decisions that regard hiring, salary administration and other terms and conditions of employment in the positive application of this policy. In addition, this policy will be made known to all employees of Kirkhill and all recruitment sources, such as employment agencies, newspapers, and all persons who come to Kirkhill for the purpose of seeking employment. If you are a qualified individual with a disability or a disabled veteran, you have a right to request a reasonable accommodation for purposes of participating in the application/hiring process. If you are unable or limited in your ability to use or access our web site as a result of your disability, you can request reasonable accommodations by calling our offices.

Voluntary EEO Survey

Yes

Voluntary EEO Survey

Government agencies require periodic reports on the sex and ethnicity of applicants and employees. This data will be used for analysis and reporting only. Submission of information is voluntary.

Gender

Male

Female

Definitions

Hispanic or Latino:A person of Cuban, Mexican, Puerto Rican, South or Central American, or other Spanish culture or origin regardless of race.
White (Not of Hispanic origin): All persons having origins in any of the original peoples of Europe, North Africa, or the Middle East.
Black (Not of Hispanic origin): All persons having origins in any of the Black racial groups of Africa.
Asian: All persons having origins in any of the original peoples of the Far East, Southeast Asia, the Indian Subcontinent
Native Hawaiian or Pacific Islander: All persons having origins in Hawaii, Guam, Samoa, or other Pacific Islands.
American Indian or Alaskan Native: All persons having origins in any of the original peoples of North America, and who maintain cultural identification through tribal affiliation or community recognition.
Two or More Races: All persons who identify with more than one of the above races.

Voluntary Background Investigation Approval Form

Yes

Background Investigation Approval Form

CALIFORNIA DISCLOSURE DOCUMENT

Kirkhill Inc. (the “Company”) may order an “investigative consumer report” (a background check report) on you in connection with your employment or application for employment (including independent contractor or volunteer assignments, as applicable). The investigative consumer report may contain information about your character, general reputation, personal characteristics, and mode of living. As allowed by law, such reports may contain the following information pertaining to you: credit history; public records; a Social Security number verification; driving records; military service; credentials/certifications; and verification of prior employment and education. The Company may not order an investigative consumer report about you without your written authorization (which you may provide through a separate document called the Authorization for Background Checks).

The agency conducting the investigation and preparing the background report for the Company is ADP Screening and Selection Services, Inc. (ADP SASS), at 301 Remington Street, Fort Collins, CO, 80524; phone number 800-367-5933; website, http://www.adpselect.com. This website contains information concerning ADP SASS’ privacy practices.

A Summary of Your Rights Under the Provisions of California Civil Code Section 1786.22

(a) An investigative consumer reporting agency shall supply files and information required under Section 1786.10 during normal business hours and on reasonable notice.

(b) Files maintained on a consumer shall be made available for the consumer's visual inspection, as follows:

(1) In person, if he appears in person and furnishes proper identification. A copy of his file shall also be available to the consumer for a fee not to exceed the actual costs of duplication services provided.

(2) By certified mail, if he makes a written request, with proper identification, for copies to be sent to a specified addressee. Investigative consumer reporting agencies complying with requests for certified mailings under this section shall not be liable for disclosures to third parties caused by mishandling of mail after such mailings leave the investigative consumer reporting agencies.

(3) A summary of all information contained in files on a consumer and required to be provided by Section 1786.10 shall be provided by telephone, if the consumer has made a written request, with proper identification for telephone disclosure, and the toll charge, if any, for the telephone call is prepaid by or charged directly to the consumer.

(c) The term "proper identification" as used in subdivision (b) shall mean that information generally deemed sufficient to identify a person. Such information includes documents such as a valid driver’s license, social security account number, military identification card, and credit cards. Only if the consumer is unable to reasonably identify himself with the information described above, may an investigative consumer reporting agency require additional information concerning the consumer's employment and personal or family history in order to verify his identity.

(d) The investigative consumer reporting agency shall provide trained personnel to explain to the consumer any information furnished him pursuant to Section 1786.10.

(e) The investigative consumer reporting agency shall provide a written explanation of any coded information contained in files maintained on a consumer. This written explanation shall be distributed whenever a file is provided to a consumer for visual inspection as required under Section 1786.22.

(f) The consumer shall be permitted to be accompanied by one other person of his choosing, who shall furnish reasonable identification. An investigative consumer reporting agency may require the consumer to furnish a written statement granting permission to the consumer reporting agency to discuss the consumer's file in such person's presence.

Minnesota and Oklahoma applicants or employees only:

Yes

Please check this box if you would like to receive a copy of a consumer report if one is obtained by the company

California applicants or employees only:

Yes

You also acknowledge receipt of the NOTICE REGARDING BACKGROUND INVESTIGATION PURSUANT TO CALIFORNIA LAW. Please check this box if you would like to receive a copy of an investigative consumer report or consumer credit report at no charge if one is obtained by the Company whenever you have a right to receive such a copy under California law.

Maiden Name

Date Changed

Other Names Used

Name

Date Changed

Name

Date Changed

List all cities and states where you have lived for the past 7 years

Current - Street City County State ZIP How long?

Street City County State ZIP How long?

Social Security Number

Driver’s License Number / State

This information will be used for background screening purposes only and will not be used as hiring criteria.

Sex

Male

Female

Date of Birth

Voluntary Self-Identification of Disability Form

Yes

Voluntary Self-Identification of Disability

Why are you being asked to complete this form?
Because we do business with the government, we must reach out to, hire, and provide equal opportunity to qualified people with disabilities.i To help us measure how well we are doing, we are asking you to tell us if you have a disability or if you ever had a disability. Completing this form is voluntary, but we hope that you will choose to fill it out. If you are applying for a job, any answer you give will be kept private and will not be used against you in any way. If you already work for us, your answer will not be used against you in any way.

Because a person may become disabled at any time, we are required to ask all of our employees to update their information every five years. You may voluntarily selfidentify as having a disability on this form without any fear of punishment because you did not identify as having a disability earlier.

How do I know if I have a disability?
You are considered to have a disability if you have a physical or mental impairment or medical condition that substantially limits a major life activity, or if you have a history or record of such an impairment or medical condition.

Disabilities include, but are not limited to:
•Blindness •Autism •Bipolar disorder •Post-traumatic stress disorder (PTSD) •Deafness •Cerebral palsy •Major depression •Obsessive Compulsive Disorder •Cancer •HIV/AIDS •Multiple Sclerosis (MS) •Impairments requiring the use of a wheelchair •Diabetes •Schizophrenia •Missing limbs or partially missing limbs •Intellectual disability (previously called mental retardation) •Epilepsy •Muscular dystrophy

Please check one of the boxes below:

YES, I HAVE A DISABILITY (or previously had a disability)

NO, I DON’T HAVE A DISABILITY

I DON’T WISH TO ANSWER

Reasonable Accommodation Notice
Federal law requires employers to provide reasonable accommodation to qualified individuals with disabilities. Please tell us if you require a reasonable accommodation to apply for a job or to perform your job. Examples of reasonable accommodation include making a change to the application process or work procedures, providing documents in an alternate format, using a sign language interpreter, or using specialized equipment.

i Section 503 of the Rehabilitation Act of 1973, as amended. For more information about this form or the equal employment obligations of Federal contractors, visit the U.S. Department of Labor’s Office of Federal Contract Compliance Programs (OFCCP) website at www.dol.gov/ofccp

PUBLIC BURDEN STATEMENT: According to the Paperwork Reduction Act of 1995 no persons are required to respond to a collection of information unless such collection displays a valid OMB control number (OMB Control Number For This Form 1250-0005). This survey should take about 5 minutes to complete.

Voluntary Post-Offer Protected Veteran Self-Identification Form

Yes

Protected Veteran Form

As a Government contractor subject to VEVRAA, we are required to submit a report to the United States Department of Labor each year identifying the number of our employees belonging to each specified “protected veteran” category. “Protected veteran” categories are identified in the Vietnam Era Veterans’ Readjustment Assistance Act of 1974, as amended by the Jobs for Veterans Act of 2002, 38 U.S.C. 4212 (“VEVRAA”), which requires Government contractors to take affirmative action to employ and advance in employment: (1) disabled veterans; (2) recently separated veterans; (3) active duty wartime or campaign badge veterans; and (4) Armed Forces service medal veterans. These classifications are defined as follows:

(1) A “disabled veteran” is one of the following:
a. A veteran of the U.S. military, ground, naval or air force 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
b. A person who was discharged or released from active duty because of a service-connected disability.
(2) A “recently separated veteran” means any veteran during the threeyear period beginning on the date of such veteran’s discharge or release from active duty in the U.S. military, ground, naval, or air service.
(3) An “active duty wartime or campaign badge veteran” means a veteran 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 under the laws administered by the Department of Defense.
(4) An “Armed Forces service medal veteran” means 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.

If you believe you are a member of any of the categories or protected veterans listed above, please indicate by checking the appropriate box below.

I BELONG TO THE FOLLOWING CLASSIFICATIONS OF PROTECTED VETERANS (CHOOSE ALL THAT APPLY):

DISABLED VETERAN

RECENTLY SEPARATED VETERAN

ACTIVE WARTIME OR CAMPAIGN BADGE VETERAN

ARMED FORCES SERVICE MEDAL VETERAN

I am a protected veteran, but I choose not to self-identify the classifications to which I belong.

I am NOT a protected veteran.

If you are a disabled veteran it would assist us if you tell us whether there are any accommodations we could make that would enable you to perform the essential functions of the job, including special equipment, changes in the physical layout of the job, changes in the way the job is customarily performed, provision of personal assistance services, or other accommodations. This information will assist us in making reasonable accommodations for your disability.

The 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 VEVRAA, as amended.

The information you submit will be kept confidential, except that (i) supervisors and managers may be informed regarding restrictions on the work or duties of disabled veterans, and regarding necessary accommodations; (ii) 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 (iii) Government officials engaged in enforcing laws administered by the Office of Federal Contract Compliance Programs, or enforcing the Americans with Disabilities Act, may be informed.

This Company abides by the requirements of 41 CFR 60-300.5(a). This regulation requires affirmative action by covered contractors to employ and advance in employment qualified protected veterans.

Please review your answers before you submit your application form

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