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An Equal Opportunity Employer

We do not discriminate on the basis of race, religion, national origin, color, sex, age, disability, or veteran status, or any other protected class.  It is our intention that all applicants be given equal opportunity and that selection decisions are based on job related performance factors.  The fact that this application is available online does not necessarily mean there are positions available, and does not in any way obligate Maymead to offer you employment.  Applications are ordinarily kept in active status for six (6) months.


Maymead Application For Employment

INSTRUCTIONS: Each question/part must be fully and accurately completed.  Further considerations may not be given until all questions/parts have been completed.


applicant log
(required by u. s. department of labor)
this section must be completed before your application will be considered

date:        name:        eeo code:   

address:   

city:        state:        zip code:   

phone number:        veteran:    yesno    if yes, which branch?:   

referral source:        position:   


general information

list the position(s) for which you are applying:


list the last three (3) companies you have worked for:


last name:        first name:        middle name:   

nickname (if applicable):        social security number:   

telephone number:        emergency contact phone number:       

emergency contact name:        emergency contact relationship:   

have you filled out an application with this company before?:    yesno    if yes,when?   

have you been employed with this company before?:    yes no    if yes,when?   

are you a citizen of the united states?:    yes no     if no, are you in the u. s. under a visa?: yesno

on what date would you be available for employment?:        rate of pay expected?:   

is there any additional information concerning a change of your name or use of another name which would help us check your work record?:
yesno    if yes, please explain below:

are you under the age of twenty-one (21)?: yesno    if under twenty-one (21) years of age, what is your current age?:   

if under twenty-one (21) of age, what is your date of birth?:   


united states military service record

were you in the armed services?: yesno    if yes, then when?:   

if yes, please detail below the job experienced gained in service:

are you a "vietnam era" veteran?: yesno    are you a "special-disabled" veteran?: yesno

type of discharge?:


education

name of your high school?:        city and state where your school was located:   

highest grade completed?:        if you did not finish high school, have you obtained your ged?:    yesno

college:        location:   

college major:        degree:   

please list below any additional educational and/or technical vocational training you have received that would be applicable to the position you are seeking:


have you been convicted of a crime or pleaded nolo contendre (no contest) to a criminal offense (other than traffic violations) in the past ten (10) years?
yesno

if yes, complete the following and list all instances even if adjuication was withheld:

name (at time of conviction or plea)                              date                              charge                                    sentence
                                         
                                         
                                         

*note: a "yes" response does not automatically disqualify an applicant from employment


in the following section it is extremely important that you give as complete and accurate information as possible.  this application asks for certain names, phone numbers, dates, etc.  if you cannot remember some of the information requested, please forward it to us as soon as possible to complete your application. if your application is to be considered further, we will contact you.  however, you may contact us at any time with questions you may have.


employment record

(begin with your current or most recent employment and go backward)

employer #1

name of company:        phone number:   

address (or location of job site):   

do we have permission to contact this company?: yesno

type of business of this company:       

dates (month/year) you were employed    from:        to:   

list your last (or current) hourly rate of pay; or annual salary:    $    hourlysalary

your last (or current) immediate supervisor was:        telephone (home):   

other supervisors you worked for with this company:   

reason for leaving (or why you are looking to leave if still employed):

list all jobs you performed for this company and the approximate length of time you worked at each job:

job title                                                                        brief description of duties                                                                length of time in job
               
               
               
               


employer #2

name of company:        phone number:   

address (or location of job site):   

do we have permission to contact this company?: yesno

type of business of this company:       

dates (month/year) you were employed    from:        to:   

list your last (or current) hourly rate of pay; or annual salary:    $    hourlysalary

your last (or current) immediate supervisor was:        telephone (home):   

other supervisors you worked for with this company:   

reason for leaving:

list all jobs you performed for this company and the approximate length of time you worked at each job:

job title                                                                        brief description of duties                                                                length of time in job
               
               
               
               


employer #3

name of company:        phone number:   

address (or location of job site):   

do we have permission to contact this company?: yesno

type of business of this company:       

dates (month/year) you were employed    from:        to:   

list your last (or current) hourly rate of pay; or annual salary:    $    hourlysalary

your last (or current) immediate supervisor was:        telephone (home):   

other supervisors you worked for with this company:   

reason for leaving:

list all jobs you performed for this Company and the approximate length of time you worked at each job:

job title                                                                        brief description of duties                                                                length of time in job
               
               
               
               


employer #4

name of company:        phone number:   

address (or location of job site):   

do we have permission to contact this company?: yesno

type of business of this company:       

dates (month/year) you were employed    from:        to:   

list your last (or current) hourly rate of pay; or annual salary:    $    hourlysalary

your last (or current) immediate supervisor was:        telephone (home):   

other supervisors you worked for with this company:   

reason for leaving:

list all jobs you performed for this company and the approximate length of time you worked at each job:

job title                                                                        brief description of duties                                                                length of time in job
               
               
               
               



important!!!!!

you must read the following statements carefully.
put your initials by each statement in the space provided.
type your full name and the date in the areas provided at the end of the section.


this company is an equal opportunity employer and considers all applicants for employment without regard to race, color, sex, religion, national origin, age, veteran status, or mental or physical disability (unless the disability prevents acceptable performance or creates a safety hazard with the work involved).
(your initials)   

i understand that either misrepresentations or omission of facts called for on this application are causes for rejection of this application; or for subsequent dismissal from employment.
(your initials)   

i understand and agree that because employment at this company is based on mutual consent, the right of the employment relationship "at will" is recognized and affirmed as a condition of employment irrespective of any other company policy, rule, or regulation.
(your initials)   

i understand that before i am employed i may be required to give a company-directed demonstration to indicate my level of ability to perform certain jobs/tasks for which i may be considered for employment.
(your initials)   

if i am employed, i agree to comply with and be bound by the safety and work rules and other rules, regulations and policies of the company.
(your initials)   

i agree to submit to a post-offer medical examination which includes a drug test; and periodic medical examinations after i am employed, for any reason, at the company's discretion.
(your initials)   

i authorize a blanket investigation of all statements contained in this application and do hereby release any and all persons, companies, educational institutions, or agencies responding to such investigation from any liability for any damage due to releasing information pertaining hereto.
(your initials)   

i understand that i do not have permission to work until all necessary paperwork has been completed and that i will not receive any pay until all necessary paperwork has been completed.
(your initials)   

i understand that in the event my application for employment is accepted, the effective date of acceptance and of my employment shall be the time i actually begin work.
(your initials)   

i understand that i will be required to provide the company with appropriate documentation to establish that i am either a u. s. citizen, u. s. national, or, if neither, that i am legally authorized to work in the united states.
(your initials)   


your full name:            date:   


equal employment opportunity voluntary questionaire

submittal of this information is strictly voluntary and refusal to provide it will not subject you to any adverse treatment

this equal employment opportunity questionnaire will be kept in a confidential file seperate from your application for employment.

qualified applicants are considered for employment, and employees are treat during employment, without regard to race, color, religion, sex, national origin and age (within the range of 40 to 70).  this policy also applies to persons who are handicapped, disabled veterans and veterans of the vietnam era.

to help us comply with federal and state equal employment opportunity record keeping, reporting, and other legal requirements, we are requesting the information below.  the information is used for statistical purposes only.

date:        your telephone number:   

first name:        last name:           middle name:   

mailing address:   

social security number:        sex:    malefemale   

race/ethnic group:    white    black    hispanic    american indian or alaskan native    asian or pacific islander

birth date:        age:        positions applied for:   

how were you referred to our company?:    walk-in    ad    agency    employee referral    other
source?:   

this employer is a government contractor subject to section 503 of the rehabilitation act of 1973 and section 402 of the viet nam era veterans readjustment assistance act of 1974 which requires government contractors to take affirmative action to employ and advance in employment qualified disabled veterans, veterans of the viet nam era and the handicapped persons.  if you are covered by these programs and would like to be considered under the affirmative action program, please tell us. providing this information is voluntary and refusal to provide it will not subject you to discharge or disciplinary treatment if you are employed.  information obtained concerning individuals relating to these questions shall be kept confidential except that supervisors and managers may be informed regarding restrictions of the work duties of disabled veterans and/or handicapped persons and regarding necessary accomodations; also, first aid personnel may be informed when and to the extent appropriate if the conditions might require emergency treatment.

are you a viet nam era veteran: (served on active duty for more than 180 days, any part of which occured between august 5, 1964 and may 7, 1975):    yesno
if yes, what is your va disability rating?:   

do you have any physical, mental, or medical impairment or disability which would limit your job performance in the job for which you are applying? please note that furnishing this information will not necessarily result in rejection for the position, but may enable the company to determine if there are other positions that you can perform or if you will be able to execute the job you are seeking with reasonable accomodations.:
yesno

if yes, please explain:   


your full name:   


voluntary self-idenification of disability
form cc-305
omb control number 1250-0005
expires 1/21/2017

why are you being asked to complete this form?

because we do business with the government, we must reach out to, hire, and provide 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 self-identify as having a disability on this form without fear of any 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 included, but are not limited to:

  • blindness

  • deafness

  • cancer

  • diabetes

  • epilepsy

  • autism

  • cerebral palsy

  • hiv/aids

  • schizophrenia

  • muscular distrophy

  • bipolar disorder

  • major depression

  • multiple sclerosis (ms)

  • missing limbs or partially missing limbs

  • post-traumatic stree disorder (ptsd)

  • obsessive compulsive disorder

  • impariments requiring the use of a wheelchair

  • intellectual disability (previously called mental retardation)

please check one of the boxes below:

yes, i have a disability

no, i don't have a disability

i don't wish to answer

your name:          date:

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. this survey should take about 5 minutes to complete.


post-offer veteran self-identification 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. if you believe you belong to any of the categories of protected veterans listed, please indicate by checking the appropriate box below.

identification categories:

disabled veterans:

  • a veteran of the u.s. military, ground, naval or air service 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

  • a person who was discharged or released from active duty because of a service-connected disability

recently separated veterans (3 years):

  • recently separated veteran means any veteran during the three-year 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.

recipients of armed forces service medal:

  • armed forces service medal veteran means any 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 ( 61 FR 1209 ).

veterans who served in active duty in a war or campaign for which a campaign badge was authorized:

  • 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.

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 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.

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 vietnam era veterans' readjustment assistance act of 1974, 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.


cdl driver addendum
(to be completed by cdl drivers only)

name:        social security number:       

cdl license#:        state:        exp. date:   

years of experience:        hazardous materials endorsement: yesno

license ever suspended/revoked?: yesno    when?:        where?:   

number of moving violations in last three (3) years?:        any accidednts in last three (3) years?:    yesno   
                                                                                                                                             when?:   

at fault?:    yesno    damage amount:    $

type of equipment operated and number of years in each:

van:        tanker:        flatbed:        other: