Employment Application

Employment Application

General, Office, Clerical, Operations & Management

Equal Opportunity Employer

(Applicants are not required to provide any information on this form that is prohibited by Federal, state or local law)

PERSONAL & GENERAL INFORMATION

Date:

* Name:

* Home Phone #:

* Current Address:

* City:

* State:

* Zip:

* Email Address:

Other Phone:

* Social Security #:

* Date of Birth:

/ /

* Position or Type of Position Desired:

* Earning Expected:

per

* Are you able to perform the essential functions of the job you are applying for, with or without reasonable accommodation?:

Yes No

* If no, please explain:

* Are you 18 years of age or older?:

Yes No

* Applying for (check all that apply):

Full-Time Part-Time Temporary

* Are you legally eligible to work in the U.S.?

Yes No

(If offered employment, you will be required to provide documentation verifying your eligibility.)

* Have you worked at Freymiller or any of its affiliates before?

Yes No

Have you ever been convicted of a crime other than a minor traffic offense?:

Yes No

If yes, please explain and provide details:

A conviction record will not necessarily be a bar to employment. Factors such as age at the time of the offense, date of conviction, seriousness and nature of the crime, and rehabilitation will be considered.

Have you ever been discharged or asked to resign from any employment?:

Yes No

If yes, please explain:

Days and hours available to work (If employed I will notify my supervisor in writing should my availability change)

Day	Sunday	Monday	Tuesday	Wednesday	Thursday	Friday	Saturday
Start
End

Are you available to work overtime?:

Yes No

Are you available to work weekends if needed?:

Yes No

Are you available to work holidays if needed?:

Yes No

If offered a position, date available to start work:

If offered a position, is there anything that would interfere with your regular attendance and punctuality?:

Yes No

If yes, please explain:

Freymiller, is an equal opportunity employer. It is our policy to provide and promote equal employment opportunity to all employees and applicants for employment in accordance with all Federal, state and local laws and regulations governing personnel activities. No person will be discriminated against in employment because of race, color, creed, religion, sex, national origin, age, ancestry, disability, veteran status or any other protected class.

EDUCATION & TRAINING

	School Name	Location (city/State)	Graduated	Course • Diploma/Degree or Certificates Earned	Dates Attended or Year Graduated	Grade Point Avg
High School (Indicate GED if applicable)			Yes No
College			Yes No
Graduate School			Yes No
Correspondence • Night School			Yes No
Technical • Business • Vocational (Include copy of certification)			Yes No

Describe any academic honors, scholarships, offices held, extracurricular activities, etc.

(You need not disclose membership in organizations that may reveal information regarding race, color, creed, sex, religion, national origin, ancestry, age, disability, veteran status or any other protected status):

MILITARY SERVICE: Have you served in the U.S. Armed Service?:

Yes No

Professional Licenses, Certificates, Registrations or Memberships Held:

Include number, where issued, effective date, and expiration date. (You need not disclose membership in organizations that may reveal information regarding race, color, creed, sex, religion, national origin, ancestry, age, disability, veteran status or any other protected status.)

Languages read, written or spoken fluently other than English:

Describe any other experience, skills, specialized courses, training, seminars, apprenticeships or other qualifications or skills you believe should be considered by Freymiller in evaluating your qualifications for employment:

Courses and/or Training not shown elsewhere in this application:

EMPLOYMENT HISTORY

Provide your full employment record, starting with your current or most recent employment, including U.S. Military Service, full-time and part- time employment. Attach an additional sheet if more space is necessary. If any employment was under a different name, indicate that name. Any periods of employment must include name, address and phone number of a person who can verify the information you have submitted. Do not exclude any employment. Freymiller reserves the right to contact all listed employers, except as noted below.

* Previous 3 employers required

Account for any period of time since leaving school (high school or college) that you were not working:

FROM	TO	REASON

Current or most recent employer

* Name:

* From:

* To:

* Are you presently employed?

Yes No

* Address:

* Phone #:

* Position Held:

* Name and Title of Immediate Supervisor:

* Contact Information (phone #):

Starting Rate of Pay:

Current or Ending Rate of Pay:

Describe your job duties, including number and type of employees supervised:

Why do you wish to leave employers?

* May we contact this employer?

Yes No

Employer

* Name:

* From:

* To:

* Address:

* Phone #:

* Position Held:

* Name and Title of Immediate Supervisor:

* Contact Information (phone #):

Starting Rate of Pay:

Current or Ending Rate of Pay:

Describe your job duties, including number and type of employees supervised:

Reason for leaving?

* May we contact this employer?

Yes No

Employer

* Name:

* From:

* To:

* Address:

* Phone #:

* Position Held:

* Name and Title of Immediate Supervisor:

* Contact Information (phone #):

Starting Rate of Pay:

Current or Ending Rate of Pay:

Describe your job duties, including number and type of employees supervised:

Reason for leaving?

* May we contact this employer?

Yes No

Conditions of employment are stated below.
Please read carefully before you sign and submit this application to Freymiller
Direct any questions you may have regarding this statement to the Human Resources Department

I CERTIFY THAT ALL INFORMATON AND ANSWERS GIVEN BY ME ON THIS APPLICATION, OR ON ANY OTHER ACCOMPANYING OR REQUIRED DOCUMENTS ARE TRUE, ACCURATE AND COMPLETE. I UNDERSTAND THAT THE FALSIFICATION, MISPRESENTATION OR OMISSION OF FACT ON THIS APPLICATION OR ANY OTHER ACCOMPANYING OR REQUIRED DOCUMENTS WILL BE CAUSE FOR DENIAL OF EMPLOYMENT OR IMMEDIATE TERMINATION OF EMPLOYMENT IF I AM ALREADY EMPLOYED, REGARDLESS OF WHEN OR HOW SUCH INFORMATION IS DISCOVERED.

I understand and agree that nothing contained in this employment application, any accompanying or required documents, or in the granting of an interview is intended to create a contractual relationship, either expressed or implied, between me and Freymiller for either employment or the provision of any benefits.

I understand that if offered a position with Freymiller, I am subject to a pre-employment drug/alcohol screening as a condition of employment. I hereby consent to the collection of a breath alcohol test and/or urine sample by the medical facility chosen by Freymiller for testing of the presence of alcohol and/or non-prescribed illegal substances, I understand and agree that a positive test result for alcohol and/or non-prescribed illegal substances based upon this drug/alcohol screening, or any refusal to cooperate with or attempt to affect the results of such drug/alcohol screening test will disqualify me from further consideration for employment by Freymiller, or if already employed by Freymiller, be cause for my immediate termination of employment. I understand and agree that if I am hired, I will be subject to drug/alcohol testing under Freymiller's Drug-Free Workplace Policy in effect at the time of my employment or as it may change from time to time during my employment.

If I am hired by Freymiller, I agree to abide by any and all of the Freymiller's policies, procedures, rules, regulations, and guidelines governing my employment in effect at the time of my hire and thereafter, and as such may change from time to time during my employment and, if applicable, after my employment terminates. I understand and agree that such abiding is a condition of employment. I further understand and agree that Freymiller, and all of its representatives or agents shall have the maximum discretion permitted by law to administer, interpret, modify, discontinue, or otherwise change all policies, procedures, rules, regulations, guidelines, documents, and/or benefits or other terms and conditions of employment from time to time with or without notice to me.

In the event I am hired by Freymiller, I further understand and agree that my employment with Freymiller will be AT WILL, for no specified duration, and may be terminated with or without cause, with or without notice, at any time, at the option of either Freymiller or me. I further understand and agree that no promise, representation, statement, document, policy, procedure, or agreement contrary to the foregoing, whether oral or written, by any representative or agent of Freymiller, at any time, can constitute a contract of employment, either expressed or implied, between me and Freymiller for any length of time or contrary to the foregoing, except as mutually agreed upon in writing between the President, CEO & CFO of Freymiller and me, and signed by both parties.

I acknowledge that I have read and understand the above statements, and hereby authorize Freymiller, its representatives, agents or vendors to investigate, be supplied with, and obtain information about any and all statements and information contained in this application and any accompanying or required documents, I understand and agree that information to be obtained or supplied about me includes, without limitation, information concerning my character, general reputation, mode of living, criminal record, work habits, financial responsibility, job performance, experience, employment, and/or reasons for employment termination. I understand that if Freymiller requests an investigative consumer report, I have the right to make a written request within a reasonable period of time to receive additional detailed information about the nature and scope of this investigation. In so authorizing, I hereby release and hold harmless any person or organization, including but not limited to any and all schools, employers, references, courts and/or anyone else who supplies information about me to Freymiller and/or any of its representatives, agents or vendors, and also release and hold harmless Freymiller, and/or any and all of its representatives, agents or vendors from any and all liability, claims and damages of whatever kind and nature that could result by reason of providing or obtaining such information, and/or having an employment decision based on making an investigation and/or utilizing such information to do so.

I understand this application is considered current for three months from the date entered on the first page herein. If I wish to be considered for employment after this period I must complete and submit a new application.
further acknowledge that by signing this application I do so willingly and voluntarily.

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Date

Applicant's Name

Call 800-378-1074
8125 SW 15th Street • Oklahoma City, OK 73128