Application For Employment As part of the application process, we may conduct background checks on applicants. "*" indicates required fields How did you hear about the position for which you are applying?* FireTron Employee Referral Billboard/Local Ad Social Media Other Name of Employee Other General InformationEQUAL OPPORTUNITY EMPLOYER. It is our policy to abide by all federal, state and local laws prohibiting employment discrimination based solely on a person's race, color, religious creed, sex, national origin, ancestry, citizenship status, pregnancy, childbirth, physical disability, mental disability, age, military status or status as a Vietnam-era or special disabled veteran, marital status, registered domestic partner or civil union status, gender (including sex stereotyping and gender identity or expression), medical condition (including, but not limited to, cancer related or HIV/AIDS related), genetic information, sexual orientation, or any other protected status except where a reasonable, bona fide occupational qualification exists.Name* First Middle Last Last 4 Digits of SSN*Current Mailing Address* Street Address City StateAlabamaAlaskaAmerican 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 How long have you lived at your current address? Email Address* Daytime Phone #Home Phone #Preferred location:*-- Please select --HoustonDallas / Fort WorthAustinCorpus ChristiCollege StationVictoriaPosition for which you are applying: Position for which you are applying: Fire Alarm Sales Representative Fire Sprinkler Sales Representative Fire Alarm Installation Technician Fire Alarm Service Technician Fire Alarm Inspector Fire Sprinkler Installer Fire Sprinkler Inspector Fire Sprinkler Helper Position for which you are applying: Fire Alarm Installation Technician Fire Alarm Helper Fire Sprinkler Fitter Fire Sprinkler Apprentice Position for which you are applying: District General Manager Operations Manager Fire Alarm Sales Representative Fire Sprinkler Sales Representative Fire Alarm Installation Technician Fire Alarm Service Technician Fire Alarm Inspector Fire Alarm Helper Fire Sprinkler Inspector Fire Sprinkler Fitter Fire Sprinkler Helper Fire Extinguisher Inspector Position for which you are applying: Fire Sprinkler Fitter Fire Sprinkler Apprentice Position for which you are applying: Fire Sprinkler Installer Fire Alarm Inspections & Service Tech Fire Sprinkler Inspections & Service Tech Fire Extinguisher Inspections & Service Tech Date available for workMonth123456789101112Day12345678910111213141516171819202122232425262728293031Year202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Minimum salary requirement? Check the following options you would consider: Full-Time Part-Time Temporary Please specify part-time hours and days available: Are you subject to any type of agreement with a current or former employer or entity that would restrict your ability to work at our company (e.g. non-compete, confidentiality, non-disclosure)?* Yes No Please explain and provide a copy of such agreement:Copy of agreementMax. file size: 50 MB.Education & TrainingPlease select all educational experience you possess: High School GED College* Graduate School Trade School *Only list college or universities accredited by the Department of Education (DOE). The DOE maintains a database of accredited institutions at http://ope.ed.gov/accreditation. High School EducationHigh School City & State Degree/Diploma Major Course of Study High School Degree Received Yes No GED EducationGED City & State Degree/Diploma Major Course of Study GED Degree Received Yes No College EducationCollege City & State Degree/Diploma Major Course of Study College Degree Received? Yes No Graduate School EducationGraduate School City & State Degree/Diploma Major Course of Study Graduate School Degree Received Yes No Trade School EducationTrade School City & State Degree/Diploma Major Course of Study Trade School Degree Received Yes No Please list course work undertaken or degree/diploma received from an unaccredited college, as well as any other education, training, special or skills that you possess related to the job: Professional Licenses / CertificationsPlease list any Professional Licenses / Certifications you posses related to the job:License or Certification #License or Certification TypeIssuing AgencyState IssuedExp. Date Add RemovePlease list any machines, equipment, or software programs on which you are qualified and experienced in operating:Please list any languages that you speak fluently: Please list any languages that you read/write fluently: Are you applying for a position which involved driving a motor vehicle in the course and scope of the employment duties?* Yes No Do you have a valid driver's license in this state?* Yes No Can you, after employement, submit verification of your legal right to work in the United States?* Yes No Are you 16 years of age or older?* Yes No Please select one of the following:* Yes, I am 16 Yes, I am 17 Yes, I am 18 or older Were you previously employed at our company?* Yes No Dates Employed: To: (month/year) Can you perform the essential functions of the job?* Yes No Do you have any relatives working for our company? Yes No Please list any relatives employed at FireTron: Employment HistoryPlease list all work experience beginning with the present or most recent job. Employment History 1Name of Employer Type of Business Address Street Address City StateAlabamaAlaskaAmerican 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 Title Phone #Name of Supervisor Title of Supervisor May we contact? Yes No Type of Employment Full-Time Part-Time Dates of Employment To: (month/year) Last Salary Reason for Leaving Brief Description of Duties Employment History 2Name of Employer Type of Business Address Street Address City StateAlabamaAlaskaAmerican 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 Title Phone #Name of Supervisor Title of Supervisor May we contact? Yes No Type of Employment Full-Time Part-Time Dates of Employment To: (month/year) Last Salary Reason for Leaving Brief Description of Duties Employment History 3Name of Employer Type of Business Address Street Address City StateAlabamaAlaskaAmerican 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 Title Phone #Name of Supervisor Title of Supervisor May we contact? Yes No Type of Employment Full-Time Part-Time Dates of Employment To: (month/year) Last Salary Reason for Leaving Brief Description of DutiesCriminal Record InformationInstructions for answering the next two questions below:A. All Applicants. Do not include convictions that were sealed, eradicated, erased, annulled by a court, expunged, pardoned, or deferred and withdrawn. B. District of Columbia, Illinois, and Rhode Island Applicants. Do not respond to the second question (regarding pending charges). C. California Applicants. Do not include: a misdemeanor conviction for possession or transportation of a small amount of marijuana (28.5 grams or less) if the conviction is more than two (2) years old; participation in any pretrial or post trial diversion program for drug or alcohol rehabilitation; or a misdemeanor conviction for which probation was successfully completed or otherwise discharged and the case was judicially dismissed. D. Colorado Applicants. Exclude information involving any record of civil or military disobedience unless such matters resulted in a plea of guilty or a conviction by a court of competent jurisdiction. E. Connecticut Applicants. You are not required to disclose the existence of any arrest, criminal charge, or conviction, the records of which have been erased. Criminal records subject to erasure are: records pertaining to a finding of delinquency or the fact that a child was a member of a family with service needs; an adjudication as a youthful offender; a criminal charge that has been dismissed or nulled (not prosecuted); a criminal charge for which the person was found not guilty; or a conviction for which the offender received an absolute pardon. Any person whose criminal records have been erased is deemed to have never been arrested within the meaning of the law as it applies to the particular proceedings that have been erased, and may so swear under oath. F. Hawaii Applicants. Do not answer the following two questions. G. Massachusetts Applicants. Do not answer the following two questions. H. Michigan Applicants. Regarding pending charges, limit your response to felony offenses. I. City of Philadelphia (Pennsylvania) Applicants. Do not respond to the first question (regarding convictions/pleas). J. Utah Applicants. Regarding convictions, limit your response to felony convictions. Do not respond to the second question (regarding pending charges).1. Convictions / Pleas.*In the past ten (10) years, have you ever been convicted of, or pled guilty or no contest to, any criminal offense other than any applicable exceptions listed above? Yes No 2. Pending Charges*Have you ever been arrested for any matters for which you are now out on bail or on your own recognizance pending trial? Yes No Criminal RecordsIf you answered Yes to either of the above two questions, please provide the date(s) and describe that criminal record so the individual circumstances can be considered. Criminal convictions or arrests will not automatically disqualify an applicant from employment.Business ReferencesPlease list three individuals, in addition to listed employment references, known to you for at least three yearsReference 1 Name Reference 1 Occupation Reference 1 Phone #Reference 2 Name Reference 2 Occupation Reference 2 Phone #Reference 3 Name Reference 3 Occupation Reference 3 Phone #Additional InformationPlease include any other information you think would be helpful to us in considering you for employment, such as additional work experience, articles/books published, activities, honors received, etc. You may omit all information that would indicate age, sex, sexual orientation, race, religion, color, national origin, or disability.Additional InformationConsentPlease read the following statement carefully:*I hereby affirm that the information provided on this application (and accompanying resume, if any) is true and complete to the best of my knowledge. I also agree that falsification or significant omission of information requested in this application or in the application process may disqualify me from further consideration for employment and may be considered justification for dismissal if discovered at a later date. I authorize all persons listed above (and on the accompanying resume, if any) to give employer and/or any service providers any and all information concerning my previous employment and education and any pertinent information they may have, personal or otherwise, and release all parties, such persons and employer and/or any service providers, from liability for any damage that may result from furnishing same to employer and/or any service providers. I understand that employer will provide workers' compensation insurance coverage for its employees. In the event of an injury in the workplace, I agree that my sole remedy lies in coverage under employer's workers' compensation insurance policy. If employed by employer, I agree to abide by the policies and procedures of employer. I further understand that my employment can be terminated, with or without cause or notice, at any time, at the discretion of employer or myself. I understand that employer may obtain a consumer and/or investigative consumer report for employment purposes that may include information regarding prior employment, work experience and performance, reasons for employment termination, and information as to character, general reputation, personal characteristics, or mode of living. The report may also contain a records check of driving, criminal, credit, education, degrees, professional licenses and/or certification records depending on the position. By signing this application, I authorize the procurement of a consumer and/or investigative consumer report by employer and/or any service providers as part of the pre-employment background investigation and if hired, at any time during my employment. California Applicants: I further understand that employer and/or any service providers may obtain Public Records about me as part of an internal background investigation and that I may waive my right to receive a copy of such Public Records by checking this box. UNDER MARYLAND LAW, AN EMPLOYER MAY NOT REQUIRE OR DEMAND, AS A CONDITION OF EMPLOYMENT, PROSPECTIVE EMPLOYMENT, OR CONTINUED EMPLOYMENT, THAT AN INDIVIDUAL SUBMIT TO OR TAKE A LIE DETECTOR OR SIMILAR TEST. AN EMPLOYER WHO VIOLATES THIS LAW IS GUILTY OF A MISDEMEANOR AND SUBJECT TO A FINE NOT EXCEEDING $100. I understand and agree that, subject to applicable law, I may be required to take a drug and alcohol screening test. I hereby give my voluntary consent for a blood and/or urine sample to be collected from me and submitted for testing. I also consent to the release of the test results to employer and/or any service providers. I understand that any positive drug or alcohol result may preclude my employment. I understand and agree to the above statement.Date & SignDate* Month Day Year Signature*eSignature**Please note: By entering your name in the below field, you are legally signing this document.