Employment Application – employment.schumanclean.com

Personal Information

First Name *

Middle Name *

Last Name *

Street Address *

City *

State *

Zip Code *

Home Phone *

Alternative Phone

Position Desired *

Expected Compensation *

What days and hours are you available to work *

If hired, can you provide documentation of your identity and eligibility for employment in the United States? *

Yes

No

If hired, you will be required to complete an I-9 form.

Have you ever been previously employed by Schuman? *

Yes

No

When were you employed by Schuman? *

What was your position? *

Education

Schools attended (check all that apply) *

High School

Name of High School

Location of High School

City/State

Number of Years Completed

Did you graduate?

Yes

No

Degree or Diploma Received/Course of Study

College

Name of College

Location of College

City/State

Number of Years Completed

Did you graduate?

Yes

No

Degree or Diploma Received/Course of Study

Trade School

Name of Trade School

Location of Trade School

City/State

Number of Years Completed

Did you graduate?

Yes

No

Degree or Diploma Received/Course of Study

Graduate School

Name of Graduate School

Location of Graduate School

City/State

Number of Years Completed

Did you graduate?

Yes

No

Degree or Diploma Received/Course of Study

Other School

Name of Other School

Location of Other School

City/State

Number of Years Completed

Did you graduate?

Yes

No

Degree or Diploma Received/Course of Study

List special licenses, skills, and certifications that would assist you in performing the duties of the job for which you have applied

Membership in professional or civic organization

(You may exclude those that disclose your race, color, religion, sex, national origin, ancestry, age, mental of physical handicap, citizenship status, marital status, or membership in any other protected class.)

Miscellaneous

Have you ever been convicted of a crime?

Yes

No

Have you been arrested for any reason that has not yet been resolved?

Yes

No

To help us evaluate your application, please describe the nature of the crime and your subsequent rehabilitation.

(A conviction will not necessarily disqualify an application.

Employment History

Previous Employer 1

Company Name

Phone

Address

City

State/Province

Zip/Postal

Name of Manager

Please indicate your Job Title and Describe Your Work

Month/Year that your employment started

Month/Year that your employment ended

Reason for Leaving

Compensation when your started employment

Compensation when you ended emplyment

Previous Employer 2

Company Name

Phone

Address

City

State/Province

Zip/Postal

Name of Manager

Please indicate your Job Title and Describe Your Work

Month/Year that your employment started

Month/Year that your employment ended

Reason for Leaving

Compensation when your started employment

Compensation when you ended emplyment

Previous Employer 3

Company Name

Phone

Address

City

State/Province

Zip/Postal

Name of Manager

Please indicate your Job Title and Describe Your Work

Month/Year that your employment started

Month/Year that your employment ended

Reason for Leaving

Compensation when your started employment

Compensation when you ended emplyment

List any other job related experiences, special training, skills, apprenticeships, internships, etc.

Applicant Statement and Authorization

(Read carefully prior to signing)

I certify that all answers given by me are true, accurate and complete. I understand that the falsification, misrepresentation or omission of facts on this application (or any other accompanying or required documents) will be cause for denial of employment or immediate termination of employment, regardless of when or how discovered.

I understand that as part of the selection process, the Company may conduct a routine investigation concerning my employment background, criminal record and education and that continued employment is contingent upon satisfactory results. I also understand that the Company may require the successful completion of a urinalysis for drug testing purposes and/or a blood alcohol test as a condition of employment. By submitting this Application for Employment, I hereby consent to either or both of said test, at the discretion of the Company.

I authorize the investigation of all statements and information contained in this application. I release from all liability anyone supplying such information and I also release the employer from all liability that might result from making an investigation. It is unlawful to require or administer to applicants for employment or prospective employment, or to any employee, a polygraph, lie detector, or similar test as a condition of employment or continued employment. Violation is punishable by criminal and civil penalties.

I understand that should an employment offer be extended to me and accepted, that I will be an at-will employee and that my employment and compensation may be terminated with or without cause, and with or without notice, at any time, at the option of either the Company or me. I understand that I must adhere to the policies, rules and regulations of employment of the Company. I further understand that no representation, whether oral or written by any representative or agent of the Company can constitute a contract of employment. I understand that the Company shall have the maximum discretion permitted by law to administer, interpret, modify, discontinue, enhance or otherwise change all policies, benefits, procedures or other terms or conditions of employment.

I acknowledge that I have read and understand the above statements.

Signature *

Clear

Notice Regarding Background Check

We appreciate your interest in pursuing a career with the Schuman Companies (“the Company”) and would like
to welcome you to our candidate selection process.

It is the policy of our Company that we check references to the fullest, for all employees prior to being hired. We
believe that hiring new employees is one of the single most important responsibilities we have. As such, we go
to great lengths determining whether or not an applicant is the best candidate for the position that we have
available. Where an applicant is applying for a position that involves access to and handling funds of the
Company, we believe that a person’s history and current credit worthiness, credit standing and credit capacity is
substantially job related, and we will generally include in our reference check a consumer report containing
information regarding those aspects of the applicants background. Information from such a consumer report
will be considered in evaluating your application to work for us.

Below is an authorization that we would like you to sign so that the Company can investigate your background.
The investigation results will not be made part of your personnel file should you be hired.

Authorization

I certify that all of the information I have given on this application is accurate and complete to the best of my knowledge. I understand that omissions and misstatements in this application may be grounds for rejection or dismissal. I authorize the Company to verify all information contained in my application, my resume, the Background Investigation Form, using such sources as:

Previous Employers
Credit Check
Education Records & Professional Certifications
Motor Vehicle Records
Federal, State, and County Criminal History Records

I hereby authorize all concerned to furnish the Company and its agents with all information they may have concerning me, whether on record or not, and do hereby release such organization, the Company, and its agents from all liability for any damages whatsoever for issuing such information. I further agree that should I accept an offer of employment, the company may need to update this information or conduct subsequent investigations from time to time during my employment, and I expressly authorize such acts. I understand that any job offer from the Company is conditional upon my satisfactory completion of a background investigation.

Signature *

Clear

Printed Name *

DRUG TEST CONSENT

CONSENT FOR PRE-EMPLOYMENT, RANDOM, POST ACCIDENT, OR REASONABLE SUSPICION DRUG TEST SCREEN AND RELEASE COVENANT NOT TO SUE AND INDEMNITY AGREEMENT

The Schuman Companies are a Drug Free Work Environment. Employees and applicants are subject to drug testing.

I hereby consent to allow Schuman’s on-site drug test or the Lab Testing Facility identified by the Company to take a specimen of my hair, urine or blood and submit it for a pre-employment, random, post-accident or reasonable suspicion drug test screen. I further consent to allow the laboratory testing service to make the results of such screen available to Schuman (“the Company”).

In consideration for such services being rendered on my behalf, I hereby release Schuman’s and/or the laboratory testing services, its officers, agents, and employees, from any and all claims which I might otherwise have due to such results being made available. I hereby consent not to file any action at law or in equity against the Company, the laboratory testing service, their respective officers, agents or employees, in connection with the results of such screen being made available, and I hereby agree to indemnify and save harmless the Company, the laboratory testing service, their respective officers, agents, and employees, from all damages, expenses, reasonable attorneys 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 available.

I understand that positive test results, refusal to be tested, or any attempt to affect the test results or test sample, will result in withdrawal of my application for employment, withdrawal of any provisional employment offer I have received from the Company, or termination of employment, depending on when results are received. I also understand that if tested positive that the specimen will be sent to an outside lab at Alere for a secondary test. In addition, once Alere has completed the secondary test, I have the right to a copy of the lab test results and that I may request an independent test on the same specimen provided. The independent test for on-site drug test can be conducted, at my expense through iCup/Alere. A Medical Review is a minimum of $15.00 and a secondary independent test a minimum fee of $25.00.

Signature *

Clear

Printed Name

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