Employment Application

Sunrise Safety Services, Inc. is an Equal Opportunity Employer

For assistance with this application, you may apply in person.
Reasonable accommodations provided upon request and as required by law.

Fill out and submit the form below and a representative will contact you.

First Name

Middle Name

Last Name

Street Address

City/State

Zip Code

Phone

If hired, can you provide evidence of legal eligibility to work in the U.S.?

Any offer of employment is conditional upon verification of form I-9 and appropriate documents for identity and work authorization.

Position Desired

Wage/Salary Desired:

Full Time Part Time

Date you can begin work?

Are you 18 years of age or older?

High school attended	City/State	Graduate?
College or techincal school	City/State	Degree?

Are you presently enrolled in school?	If yes, give name & address of school and expected completion date
List any job-related certifications, skills, or accomplishments, including military service:

Your availability for work
	Monday	Tuesday	Wednesday	Thursday	Friday	Saturday	Sunday
From
To

Total hours per week you are available to work	Do you have any special requests or needs for a work schedule?
Are you available for overtime? Yes   No

Provide Three References - Not Former Employers or Family Members - Who We May Contact
Name	Relationship to person - length of time known	Phone Number

Required Fields were left blank

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Employment History

List previous employers - Current employer first.

May we contact your current employer before you are offered a position?

Yes   No

Name of Employer

Job Title

Duties

Address

Dates of Employment - From

Dates of Employment - To

City, State, Zip Code

Starting Hourly Pay or Salary

Ending Hourly Pay or Salary

Supervisor Name

Supervisor Phone

Reason for Leaving

Name of Employer

Job Title

Duties

Address

Dates of Employment - From

Dates of Employment - To

City, State, Zip Code

Starting Hourly Pay or Salary

Ending Hourly Pay or Salary

Supervisor Name

Supervisor Phone

Reason for Leaving

Name of Employer

Job Title

Duties

Address

Dates of Employment - From

Dates of Employment - To

City, State, Zip Code

Starting Hourly Pay or Salary

Ending Hourly Pay or Salary

Supervisor Name

Supervisor Phone

Reason for Leaving

In case of Emergency who should we contact
Name	Relationship	Phone Number	Address
Name	Relationship	Phone Number	Address

Required Fields were left blank

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Carefully read each statement before signing at the bottom

Drug Screening

I understand and agree that Sunrise Safety Services, Inc. may request without prior notification or warning, a Drug screening to be performed for Pre-Employment testing, or if employed, a random screening at any time during my employment.

Driving Record Release

Sunrise Safety Services requires an MVA Driver's Record when considering me for employment. I authorize the MVA to release that information to Sunrise Safety Services, Inc. This release is valid as long as I am an employee or employee candidate and may only be rescinded in writing.

Authorization for MVA Review

I understand that as a potential driver of a company vehicle, it will be my responsibility to operate the vehicle in a safe manner and to drive defensively to prevent injuries and property damage. I also understand that, if employed by Sunrise Safety Services, Inc., my Motor Vehicle Record will be periodically reviewed to determine my continued eligibility to drive a company vehicle. In accordance with the Fair Credit Reporting Act, I have been informed that a Motor Vehicle Record will be periodically obtained on me for continued employment purposes.

I acknowledge that I have read the disclosure and authorize Sunrise or its designated agent to obtain a Motor Vehicle Record report. This authorization is valid as long as I am an employee or employee candidate and may only be rescinded in writing.

Print Name
Driver's License Number

I certify that all of the information provided in this employment application is true and complete to the best of my knowledge, and I authorize investigation of all statements contained in this application, including a criminal background, drug test, and credit history check (if applicable for position). I understand that any false or incomplete information may disqualify me from further consideration for employment and may result in my immediate discharge if discovered at a later date.

I authorize the investigation of any or all statements contained in this application and also authorize any person, school, current employer, past employers, and other organizations to provide information concerning my previous employment and other relevant information that may be useful in making a hiring decision. I release such persons and organizations from any legal liability in making such statements. I also understand and agree that no representative of the company has any authority to enter into any agreement for employment for any specified period of time, or to make any agreement contrary to the foregoing, unless it is in writing and signed by an authorized company representative.

I understand that employment with Sunrise is at will, so that both Sunrise and I remain free to choose to end our work relationship at any time, with or without cause, and with or without prior notice.

THE REHABILITATION ACT OF 1973 AND THE VIETNAM ERA VETERAN'S READJUSTMENT ASSISTANCE ACT OF 1974 VOLUNTARY DISCLOSURE FORM

Sunrise Safety Services, Inc. employees are treated during employment without regard to race, religion, color, sex, national origin, age, disability or veteran status. We invite you to answer the questions below. Submission of this information is voluntary. A decision not to provide it will not subject you to any adverse treatment. All information will be kept confidential and will be used in accordance with applicable laws and regulations.

DISABLED - I am a qualified disabled person, i.e. I have a physical or mental impairment which substantially limits one or more of those major life activities which affects my employability. I have a record of such impairment or I am regarded as having such impairment.

A DISABLED VETERAN - I am a qualified disabled veteran, i.e. I am entitled to a disability compensation underthe laws administered by the Veterans Administration for a disability orated at 30% or more OR I was discharged or released from active duty for a disability incurred or aggravated in the line of duty.

A VIETNAM ERA VETERAN - I am a veteran of the Vietnam Era, i.e. I served on active duty for more than 300days, any part of which occurred between August 5, 1964 thru May 7 1975, and I was discharged with other than a dishonorable discharge; or I was discharged or released from active duty for a service-connected disability during the same period.

VOLUNTARY SELF-IDENTIFICATION FORM

Sunrise Safety Services, Inc. is an equal opportunity employer that is committed to a program of recruiting females and minority group members. In order to help us to comply with government record keeping, reporting and other legal requirements we ask that you complete this form. The information will not be used in evaluating your application for employment. Completion of this form is voluntary

.

Name

Date

Position Applied For

How did you learn about Sunrise Safety and/or the position (please check all that apply):

Newspaper/Advertisement

Employment Agency

Referred by Sunrise Employee

Referred by my School

Unsolicited walk-in, resume or application

Other (please explain)

Gender

  Male  Female

Race

  Alaskan Native  Black  Native American  Asian Pacific  Hispanic  White  Other

I have read, understand, and agree to all of the above statements.

Signature:
Date:

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