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Application for Employment
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Date Available to Start Work:
MM slash DD slash YYYY
Position(s) Applied For:
Laborer
Operator
Driver
Office
Supervisor
Other
Have you ever been employed by M CON, LLC before?
Yes
No
Have you filed an application with M CON, LLC before?
Yes
No
If available, please upload resume:
If you upload your resume here, you can skip education and employment sections below.
Drop files here or
Select files
Max. file size: 128 MB.
Education
Highest Level of Education
Degree/Diploma?
Major or Specialized Training & Skills
Employment History
Name of Employer
From:
Month
Day
Year
To:
Month
Day
Year
Job Titles & Duties
Reason For Leaving
Additional Employment to Add?
Yes
Name of Employer
From:
Month
Day
Year
To:
Month
Day
Year
Job Titles & Duties
Reason For Leaving
Additional Employment to Add?
Yes
Name of Employer
To:
Month
Day
Year
From:
Month
Day
Year
Job Titles & Duties
Reason For Leaving
If hired, would you have reliable means of transportation to and from work?
Yes
No
Can you travel if the position requires it?
Yes
No
Are you willing to work overtime / weekends?
Yes
No
Are you able to work on your feet for 10 hours a day?
Yes
No
Are you able to lift 50 pounds consistently and up to 100 pounds occasionally?
Yes
No
Can you perform the essential function of this job with or without reasonable accommodations?
(If you have any questions about the functions of the job, please ask the interviewers before answering the question.)
Yes
No
Maybe
Do you have construction experience?
Yes
No
If yes, please explain i.e., waterlines, sewer lines, directional drilling etc.:
Do you have a valid driver’s license?
Yes
No
Valid CDL?
Yes
No
If yes, what class?
Class A
Class B
Any license or CDL restrictions?
Experience / Certifications
What type of tools have you worked with?
Drills
Cutting Torches
Welder
Wrenches
Other
Describe any additional experience or training that qualifies you for this job?
Bobcat
Backhoe
Dozer
Trencher
Directional Bore Machine
Other
Have you completed OSHA Training and possess a card or certificate?
Yes, 30hr
Yes, 10hr
No
What type of experience, if any, of operating machinery do you have and what machines/equipment?
Background Information
Have you ever been convicted of a crime?
(Conviction will not necessarily disqualify an applicant from employment. The recency, severity, and pertinence of the conviction to the job will be considered.)
Yes
No
If yes, please explain:
Are you on probation or parole?
Yes
No
Are you able to work out of state and/or near schools?
Yes
No
Will you take an alcohol/drug screen breath/urine test for drug, alcohol, or controlled substance?
Yes
No
Are you able to speak, understand spoken English and follow verbal and written instructions in English?
Yes
No
Application Acknowledgments and Policies
Did you personally complete this application?
Yes
No
Consent
(Required)
Applicant Acknowledgment
In connection with this application for employment, I authorize the employer and any agent acting on its behalf to conduct an inquiry into any job-related information contained in this application, including, but not limited to, my records maintained by an educational institution relating to academic performance such as transcripts. Moreover, I hereby release the employer and any agent acting on its behalf from any and all liability of whatsoever nature by reason of requesting such information from any person.
I hereby understand and acknowledge that, unless otherwise defined by applicable law, employment relationship with this organization is of an “at will” nature, which means that the Employee may resign at any time and the Employer may discharge at any time with or without cause. It is further understood that this “at will” employment relationship may not be changed by any written document or by conduct unless such change is specifically acknowledged in writing by an authorized executive of this organization.
In the event of employment, I understand that false and misleading information given in my application or interview(s) may result in discharge. I understand that I am required to abide by all rules and regulations of the employer.
Controlled Substance / Alcohol Testing Policy
I acknowledge receipt and agree that I have read and understand the Controlled Substance and Alcohol Testing Policy and Procedures of M CON, LLC. I further acknowledge and agree that I will abide by these policies and understand that violation of these policies will result in permanent disqualification. I understand and agree that I will be subject to random controlled substance and alcohol testing to see fit by Pipeline Testing Consortium, Inc. and/ or Mosaic Occupational Medicine, or M CON, LLC. I also understand that M CON, LLC reserves the right to modify this policy as changes and conditions in the regulations, law, and business occur.
VIOLATION
An operator / laborer is in violation of this business policy whenever he / she is found to have engaged in drug and / or alcohol use prohibited by this policy and / or in violation of Pipe Line Testing Consortium, Inc. and Mosaic Occupational Medicine alcohol misuse and controlled substance regulations.
CONSEQUENCES FOR VIOLATION
Violation of the business policy, Pipe Line Testing Consortium, Inc. and Mosaic Occupational Medicine alcohol misuse andcontrolled substance use regulations will result in the following consequences:
The operator / laborer will be immediately removed from a safety sensitive function.
The operator / laborer cannot return to safety sensitive duties for M CON, LLC.
The operator / laborer having an alcohol concentration of 0.02 – 0.039 when tested, must be removed from safety sensitive functions for at least 24 hours.
PROHIBITED DRUG USE
Pipeline Testing Consortium, Inc. and M CON, LLC rules prohibit covered operators and / or laborers from reporting for or performing safety sensitive functions:
When using any controlled substance, except a prescription that does not adversely affect his / her ability to safely operate a commercial motor vehicle. Additionally, operators and / or laborers must inform the company of any therapeutic drug use, before performing safety sensitive:
Amphetamines / Methamphetamines Cocaine
Opiates Phencyclidine
THC (marijuana, hashish, etc.)
DRUG AND ALCOHOL TESTING PROCEDURES
In order to protect the operator / laborer and the integrity of the testing process, safeguard the validity of the test result and ensure those results are attributed to the correct operator / laborer, all drug and alcohol testing shall be performed in accordance with the procedures defined by the Department of Transportation, Pipeline Testing Consortium, Inc. and M CON, LLC.
SUBMISSION TO TESTING
No operator / laborer shall refuse to submit to any drug and / or alcohol testing required by this policy and / or Pipeline Testing Consortium, Inc., Mosaic Occupational Medicine, and M CON, LLC alcohol misuse and controlled substance use regulations. Refusal to submit to any / or all types of alcohol or controlled substance testing procedures will be treated as a positive result, an act of gross misconduct and will be grounds for refusal of qualification for an applicant and disqualification for an existing operator / laborer.
An operator / laborer shall be deemed to have refused to submit to an alcohol and / or controlled substance test when the operator / laborer:
1. Fails to provide adequate breath or saliva for testing without valid medical explanation after he /she has received notice of alcohol testing required by DOT regulations and company policy.
2. Fails to provide adequate urine for controlled substances testing without a valid medical explanation after he / she has received notice for controlled substance testing required by DOT regulations and company policy.
3. Engages in conduct that clearly obstructs the testing process.
* Please refer to U.S. Department of Transportation Drug and Alcohol Policy and Compliance. You may do so at 202-366-DRUG (3784) or visit their website at www.dot.gov/odapc or reference to the employee copy provided in the employee office at M CON, LLC
Motor vehicle Report Authorization Form
As an employee or a prospective employee of M CON, LLC, please be aware of Motor Vehicle Report (MVR) will be requested to review your past driving history. The review is part of our employment screening process to ensure eligibility under our commercial insurance program in the event your job responsibilities would include operating company vehicles.
Your signed consent is required under the Federal Fair Credit Reporting Act when accessing Motor Vehicle Reports for employment purposes. Please be advised, M CON, LLC will initialize the MVR for employment purposes, including hiring and promotion decisions, only if written consent is received.
Section 604 of the FCRA contains a list of the permissible purposes under law in which we may use a Consumer Report (MVR). To obtain a copy if the FCRA complete report, please contact the Federal Trade Commissioner (website at http://www.ftc.gov). A summary of the Consumer Rights under the Fair Credit Reporting Act will be provided to M CON, LLC with every MVR that is obtained for employment purposes. Please advise if you wish to receive a copy of this report.
I Hereby Agree, I have read and understand the above information regarding the formality of using Motor Vehicle Reports for the employment purposes, including hiring and promotional decisions by M CON, LLC.
Therefore, I authorize M CON, LLC to request a Motor Vehicle Report for the above stated purposes. However, if employment is denied based on Adverse Action due to the information obtained from MVR, I understand I am entitled to oral or written notification within 30 days from M CON, LLC.
I have read, understand, and agree to all of the above terms and that the information provided is true and complete.
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