Fort Smith Industrial Kiosk Application Step 1 of 4 25% Confidential InformationWe are committed to your privacy and protection of your personal information. We will not sell or rent personally identifiable information to any third party for any purpose.TEC/CPR is an equal opportunity employer. All applicants meeting our occupational qualifications and who can perform the essential functions of the job applied for will be provided employment opportunities without regard to race, color, religion, gender, age, national origin, disability, military status, sexual orientation or any other classification protected by federal, state or local law.Your Home OfficeFort SmithPlease select the TEC location you wish to use as your home office. This is where you will interact and receive your pay.Date* MM slash DD slash YYYY Name* First Middle Last Other Name/s Used First Middle Last Email Please Enter Your Address Information Below* Street Address City AlabamaAlaskaAmerican 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 Home Phone*Cell PhoneEmployment Agreement* I agreeI certify that the information submitted on this application is accurate. I hereby grant TEC/CPR permission to verify my employment, education and credit history and to solicit and secure other information which may be required to determine my suitability for employment. A copy of this authorization bearing my signature has the same force and effect as the original. I understand that I may be subject to random drug testing by TEC/CPR or its client companies and consent to be tested randomly or after any on the job accident or injury. I further consent to have the results of my drug test released to any company that may request this information and release TEC/CPR and/or its agents from any and all liability arising from the release of this information. I understand that Arkansas and Oklahoma are "at will" employment states and that I may be terminated at any time at the discretion of my employer, with or without cause. If I have an unexcused absence, walk off, or leave a job early, I will be subject to minimum wage for that week. I understand that I must notify TEC/CPR of all on the job injuries at the time of injury. Initial reports may be made by telephone, but a written report must be filed at the TEC/CPR office by 5:00 p.m. the next day. Weekend accident reports should be called in to TEC/CPR immediately and then a written report must be filed by 5:00 p.m. on Monday. Seeking medical treatment before notifying TEC/CPR will result in paying your own medical bills until notifying TEC/CPR in writing (AR Stat. 81-1317). TEC Staffing Services and CPR are a temporary service and for that reason is unable to guarantee to keep me busy all the time I might be available. With that in mind, I wish temporary work rather than permanent. I understand and agree to contact TEC/CPR within 24 hours and on a daily basis after completing any assignment to determine if other work is available for me. Otherwise, TEC/CPR may assume I am terminating my employment with them. I understand that failure to contact TEC/CPR as agreed will result in denial of unemployment benefits. This agreement will remain in force indefinitely, until reevaluation is deemed necessary by TEC/CPR. Signature____________________________________Date:____________Code of Conduct* I agree.TEC/CPR is strongly committed to providing quality service to its client companies. In furtherance of this commitment, each TEC/CPR employee is required to be productive, reliable and trustworthy. To assist employees in meeting these requirements, TEC/CPR provides the following list of conduct, which is prohibited and will subject an employee to disciplinary action, up to and including termination. This is not an exhaustive list of every form of conduct (list is subject to modification): Distribution, possession or use of alcohol or any illegal drug while on duty at the work site is prohibited. Reporting to work or performing duties while under the influence of alcohol or any illegal drug is prohibited. The term “illegal drug” includes but is not limited to marijuana and any prescription drug used in contravention of a physician’s orders. If the company determines that your use of a prescription drug impacts your ability to safely perform the essential functions of your job assignment or poses a risk to others, reasonable accommodations will be considered. Unauthorized possession, use, or removal of company property. Falsification or misrepresentation of any company document, including but not limited to, the TEC/CPR application for employment, workers compensation claim, payroll records and post hire questionnaire. Violating TEC/CPR or company rules regarding confidentiality or information and materials received by the employee in the course of performing job duties. Sexual harassment or any other form of harassment or intimidation of co-workers or other individuals at the work site or while engaged in company business. Possessing firearms, explosives or other weapons while at the work site or engaged in company business. Individuals with a concealed weapons permit are subject to this prohibition. Inappropriate behavior including but not limited to fighting, horseplay, language, practical jokes or pranks at the work site that would reflect negatively on TEC/CPR and TEC/CPR employees. Failing to follow prescribed call-in procedures in the event of absence/tardiness. One unexcused absence, or one no show with call (not showing up after accepting an assignment but notifying TEC/CPR within a half hour before or after starting time). Being late for work, walking off the job, not calling in when not showing up for an assignment you accepted. Failing to follow any other policies/procedures established at the employee's work site. Insubordination to TEC/CPR staff, co-workers or other individuals at the work site or while engaged in company business. Inadequate or substandard work performance. Failure to report an accident/injury, at the time of the injury, to TEC/CPR on the 24 Hour Injury Line. Signature________________________________________Date________Safety Guidelines* I agreeSpecific Assignment Guidelines 1. Contact the supervisor immediately upon arrival at the job site and ask for specific safety instructions, required personal protective equipment and job site orientation. General Safety Information 1. If injured at the job site you must contact TEC Loss Prevention immediately at the 24 hour injury line 479-785-3022. 2. Always wear a hard hat in designated "hard hat" areas. 3. Always wear safety glasses or goggles, earplugs, safety gloves and other personal protective equipment where advised or required. The company you are assigned to may provide personal protective equipment, or check with your TEC supervisor for instructions. 4. Do not operate any equipment, which, in your opinion, is not in safe condition. Report any hazardous conditions to your job site supervisor. 5. Never attempt to bypass any machine safety guards. Any safety guards not in place on a machine, not in proper working condition, or not properly used, must be reported to your job sight supervisor immediately. Never tamper with machine safety guards, electrical circuits or switches. 6. Obey all company rules, government regulations, signs, markings and instructions. Be familiar with those that apply to you. If you don't know, ask your job site supervisor. 7. When lifting, use only the approved lifting technique: bend your knees, grasp the load firmly, then raise the load keeping your back as straight as possible, pushing up with your legs. Get help for heavy loads. Report any change in assignments to your TEC supervisor immediately. 8. Do not become involved in workplace horseplay. Horseplay, roughhousing, and practical jokes frequently cause serious injury and they are not permitted on the job. 9. Do not distract or startle fellow workers while working. Avoid all unnecessary talking, shouting, or loud noises that may take the attention of other employees away from their work and create a safety hazard. 10. Use only the proper tools and equipment for the job, and use them safely. Check with your job site supervisor for authorization and instruction for tools and equipment. 11. Be constantly alert for moving equipment and loads. Always stand clear of operating machinery and equipment. 12. Each employee is responsible for keeping their work area clean and free of objects that may create a safety hazard. Report any spilled liquid to your job site supervisor immediately. 13. When ascending or descending steps or stairs, use the handrail to give support and balance. When ascending or descending ladders, always use proper ladder safety techniques and never come down the ladder facing frontwards. 14. Walk, do not run in any plant area. 15. Open doors slowly, using the handle or push plate. 16. Do not go into rooms or stairways that are not properly lit. 17. TEC employees are not allowed on roofs, or to climb to heights over six feet. 18. The use of drugs and/or alcoholic beverages on client property is prohibited. 19. Smoking restrictions must be observed for each job site. 20. Do not operate a forklift or motorized equipment without receiving proper training and/or certification. Signature______________________________________Date__________Consent for Reference & Background Checking I agreeI hereby grant TEC/CPR Staffing Services permission to verify my employment history, solicit or secure other information, and perform a background check. These may be required to determine my suitability for employment. A copy of this authorization bearing my signature has the same force and effect as the original. I further consent to have the results released to any company that may request this information and release TEC/CPR and/or its agents from any and all liability arising from the release of this information. I also acknowledge that I have received a copy of the Health Insurance Marketplace Coverage Form. I______________________________, hereby give consent to any and all previous employers of mine to provide information regarding my employment with previous employers to TEC/CPR Staffing Services. This consent is given in accordance with ACT 474 of the 1999 General Assembly of the State of Arkansas. Date of Release:_______________________ Signature:_____________________________________________________ Social Security Number_______________________________________Minimum Pay Rate Acceptable* Please enter a per hour rate. We want to meet your expectation.Available to work?* Full Time Part Time Temporary Temp to Hire Shifts available to work?* 1st 2nd 3rd Weekend Are you authorized to work in the U.S.* Yes How did you hear about TEC Staffing*Please SelectGoogleFacebookCraigslistIndeedFriend / RelativeJob Fair / Hiring EventSign / Billboard / FlyerWalk inOtherOther Source Drivers Lic Number To be used in the event driving is required as part of the essential duties of the jobState Issuing Drivers License Expiration Date of License MM slash DD slash YYYY How many tickets have you had in the last 3 years? Type of transportationPlease SelectCarPublic TransportationWalkBikeOtherHave you applied with TEC Staffing Services before?* Yes No When MM slash DD slash YYYY Have you ever been convicted of any law violation other than a minor traffic violation?* Yes No Criminal convictions are not an absolute bar to employment.Date of Conviction* MM slash DD slash YYYY Charge & Status*MisdemeanorFelonyCurrently on ProbationPlease Explain*Please be as detailed as possible.Have you ever been a temporary employee with another service before?* Yes No What temporary staffing company were you employed with in the past? When were you last employed with them? MM slash DD slash YYYY Emergency Contact Information* First Last Street Address City State / Province / Region ZIP / Postal Code Emergency Contact Phone* Education and Certifications Name of High School Attended Graduate or GED* Yes No Name of College/s Attended Graduate Yes No College InformationCourse of StudyHours Completed Certifications, Diplomas, or Specialty TrainingPlease list any additional, Certifications, Diplomas, or Specialty Training you have completed. Employment History Please list a minimum of 10 years or at least 5 of your past employers, Starting with the most recent. If you have less than 10 years of employment please enter what you have.Previous Employer Information*Company NamePhoneEmployment Information*From DateTo DateSalary Street Address City AlabamaAlaskaAmerican 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 Supervisor Information*First NameLast NamePhoneTitle and Job Duties*Reason for leaving* List Employer 2? Yes Previous Employer InformationCompany NamePhoneEmployment InformationFrom DateTo DateSalary Street Address City AlabamaAlaskaAmerican 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 Supervisor InformationFirst NameLast NamePhoneTitle and Job DutiesReason for leaving List Employer 3? Yes Previous Employer InformationCompany NamePhoneEmployment InformationFrom DateTo DateSalary Street Address City AlabamaAlaskaAmerican 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 Supervisor InformationFirst NameLast NamePhoneTitle and Job DutiesReason for leaving List Employer 4 Yes Previous Employer InformationCompany NamePhoneEmployment InformationFrom DateTo DateSalary Street Address City AlabamaAlaskaAmerican 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 Supervisor InformationFirst NameLast NamePhoneTitle & Job DutiesReason for leaving List Employer 5 Yes Previous Employer InformationCompany NamePhoneEmployment InformationFrom DateTo DateSalary Street Address City AlabamaAlaskaAmerican 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 Supervisor InformationFirst NameLast NamePhoneTitle & Job DutiesReason for leaving Skills and Experience Please select only skills and experience that is represented in your previously listed work historyEquipment OwnedPlease select the equipment that you currently own. Hard Hat Steel Toe Boots Metatarsal Boots Rubber Boots Own Tools Welding Hood Work Boots Slip Resistant Shoes Industrial Maintenance Janitor Apartment Maintenance Electrical Industrial Maintenance Hydraulic Mechanic Pneumatic Refrigeration Trouble Shooting PLC Electronics Service and Repair Apprentice Electrician apprentice Plumber Boiler Operator Landscaping Landscaping Design Lawn Care Planting Manufacturing Assembly Band Saw Finisher Glue Gun Lathe Machine Operator Mill Sander Screw Gun Set-up Shear Sprayer Stain Staple Saw Operator Upholstery Installer Press Operator Offset Operator Collate Machine Flex Operator Safety Training Purchasing Injection Molding Blow Mold Inspect Glass Plant MISC - Other Dishwasher Waitress/Server Food Prep Cashier Housekeeping Janitorial Servers Security Guard Black Pants & Shoes Catering Electronic Repair Soldering Circuit Board Assembly Computer Skills Construction Heavy Equipment Operator Skid Steer Operator Bob Cat Operator Mason/Brick Layer Carpet Layer Commercial Painter Concrete Finisher Ductwork Installer Frame Carpentry Sheetrock Hanger Drywall Finisher Finish Carpenter Carpentry Helper Cabinet Maker Interior Painter Exterior Painter Door Installation Blueprint Reading Tape Measure Trucking Bobtail CARCO Certified CDL Class A CDL Class B Diesel Mechanic DOT Certified Flatbed Ryder Certified HAZMAT Endorsement Truck Wash Standard Transmission Chauffeur's License Delivery Quality Quality Control Quality Assurance Glass Inspector Automotive Alignment Autobody Auto Mechanic A.S.E. Certified Brakes Detail Fiberglass Lube Oil Tech Parts / Counter Tire Changer Own Tools Warehouse Lumper Inventory Shipping/Receiving Certified Forklift Squeeze Forklift Forklift Mechanic Cold Storage Stocking Pallet Jack / Electric Materials Handler Electric Forklift Gas Forklift Forklift Propane Forklift Sitdown Forklift Standup Forklift Delivery Distribution Freezer Clamp / Squeeze Forklift Racking Computerized Machine Oper. Drill Press Plastics Airbrush Computerized Machine Oper. Drill Press Machine Operator Mixer Molder Mold Machine Poultry Debone Freezer Live Hang Packing P/C Cutter Quality Control Rubber Boots Sanitation Support Trimmer Will Work Poultry Metal Aluminum Arc Welder Blueprint Reading CNC Cold Weld Computerized Machine Op. Cutting Torch Foundry Grinder Heliarc Welder Lathe Machinist Micrometer Mig Welder Press Brake Set-up Shear Operator Sheet Metal Sheet Metal Fabrication Shop Welder Spot Welder Stainless Steel Welder Steel Surface Grinder Tape Measure Tig Welder Stick Welder Wire Welder Powder Coat Die Cast Machine Shop Drill Press U.S. Armed Forces U.S. Coast Guard U.S. Army U.S. Air Force U.S. Marine Corps U.S. Navy Heating & Air Installation Maintenance Repair HVAC License Textiles Cutter Double Needle Seamstress Single Needle Seamstress Spreader Industrial Seamstress Seamstress PhoneThis field is for validation purposes and should be left unchanged.
