Please complete the following form to submit your employment application to Barnes. Barnes is an equal opportunity employer. Prospective employees will receive consideration regardless of age, race, creed, color, handicap, marital status, sex, national origin, ancestry, sexual orientation, arrest or conviction record, or veteran status. Personal Information - Contact First Name: Middle: Last Name: Address 1: Address 2: City: State: Zip Code: Home Phone: Work Phone: Personal Information - Position / Availability Position Applying For: Pay Rate Expected: Are you legally eligible for work in the United States? Yes No Are you current a student? Yes No Have you worked for Barnes, Inc. before? Yes No ... If yes, when? Do you have a valid driver's license? Yes No ... If yes, what is your license number? Are you available for full-time work? Yes No Date Available to Begin Work: Describe any specific training or professional experience which you feel makes you a desirable candidate for this position: Education SchoolYearsCompletedDiploma/DegreeArea of Study Position-Specific Questions Mechanic/Shop, Landscape and Landscape Maintenance Division and Snow Removal Positions Has your employment been terminated or have you been convicted of or do you have charges pending against you for driving while under the influence of alcohol or drugs or other non-misdemeanor traffic or driving related violations? Yes No Has your employment been terminated or have you been convicted of or do you have charges pending against you for theft, larceny, burglary, violent crimes against the person, trespassing, robbery, arson or criminal damage to property? (Existence of a criminal record does not constitute an automatic bar from consideration, and your record will be considered only as applicable to the position for which you are applying.) Yes No If yes, list date and circumstances for each conviction, pending charge or termination below: Mechanic/Shop, Landscape and Landscape Maintenance Division and Snow Removal Positions Has your employment been terminated or have you been convicted of or do you have charges pending against you for forgery, embezzlement, larceny or financial transaction card crimes? Yes No If yes, list date and circumstances for each conviction, pending charge or termination below: Military Did you serve in the U.S. Armed Forces? Yes No ... If yes, what branch? Describe any special training you received which might be relevant to the position for which you are applying: Employment Please give accurate and complete information. Start with your present or most recent employer. Employer 1 Business: Telephone: Address 1: Address 2: City: State: Zip: Dates Employed: - Pay Rate: Start Last Supervisor Name: Job title and duties performed: Reason For Leaving: Employer 2 Business: Telephone: Address 1: Address 2: City: State: Zip: Dates Employed: - Pay Rate: Start Last Supervisor Name: Job title and duties performed: Reason For Leaving: Employer 3 Business: Telephone: Address 1: Address 2: City: State: Zip: Dates Employed: - Pay Rate: Start Last Supervisor Name: Job title and duties performed: Reason For Leaving: We may contact the employers listed above unless you indicate those you do not want us to contact. Name: Reason: Personal References Please list two personal references who are familiar with you, excluding family members or previous employers. Reference 1 Name: Telephone: Address 1: Address 2: City: State: Zip: Nature of Relationship: Reference 2 Name: Telephone: Address 1: Address 2: City: State: Zip: Nature of Relationship: Do you have the ability to perform all of the duties and meet the time and work requirements of this job? Landscape, mowing and shop positions will require walking, bending, climbing, squatting, carrying, lifting and reaching. How did you hear about Barnes, Inc.? Billboard Friend Newspaper Now Hiring Sign Radio Website Other: Applicant EEO/Affirmative Action Background Form It is the policy of Barnes, Inc., to provide equal employment opportunity to all qualified applicants for employment without regard to personal characteristics, including race, color, religion, national origin, sex, sexual orientation, age, veteran status, or disability. Various agencies of the government require employers to invite applicants to identify themselves. That is the only goal of this part of your application. Completing this section of the application is voluntary and in no way affects the decision regarding your application for employment. This form is confidential and we will maintain it separately from the rest of your application form. First Name: Middle Name: Last Name: Position applied for (list only one): Referred by: Race/ethnic origin: White Hispanic American Indian/Alaskan Native Black/African American Asian Native Hawaiian/Pacific Islander Sex:Male Female Are you a Vietnam Era Veteran? You qualify if you are a person who served on active dury for a period of more than 180 days, any part of which occurred between 8/5/64 and 5/7/75, and was discharged or released therefrom with other than a dishonorable discharge or for a service connected with disability. Yes No Are you a disabled veteran? You qualify and are entitled to disability compensation under laws administered by the Department of Veterans Affairs for a disability rated at 30% or more, or are a person whose discharge or release from active duty was for a disability incurred or aggravated in the line of duty. Yes No Do you have a mental or physical disability? You qualify if you are a person who has a mental or physical impairment that substantially limits one or more major life activities, who has a record of such impairment, or who is regarded as having such an impairment. Yes No Please Read Carefully Before Submitting Drug Testing I understand that Barnes, Inc. reserves the right to require me to submit to a drug or alcohol screening test prior to beginning employment and at any time after beginning employment and during employment, and may also require me to submit to work-related medical examinations during the course of my employment. Certification of Truthfulness & Reference Check Authorization I certify that the information I have provided in this application is true and correct to the best of my knowledge, and I understand that falsification of information, failure to complete, or unsatisfactory references are grounds for rejection of this application or, if hired, dismissal. I authorize Barnes, Inc. to contact and secure information about my educational background, work experience, credit rating, and to secure records of licensing, administrative, regulatory or other governmental agency, and to contact any other information source relevant to employability.* I hereby release Barnes, Inc., and its officers and agents from liability for seeking such information, and all other persons, schools, corporations, or organizations for furnishing such information. Understanding Employer-At-Will I understand that Barnes, Inc., is an Employer-At-Will, which means that if employed, my employment is for no definite period and that acceptance of an offer of employment does not constitute or create a contractual obligation upon Barnes, Inc. to continue to employ me in the future, and that my employment may be terminated at any time, with or without cause, by either party. No employee of Barnes, Inc. is authorized to offer me anything contrary to what is stated above, and I may not rely on any such representations. I have read and understood the above paragraphs.
