Employment Application

APPLICATION FOR EMPLOYMENT

This information will not be the only basis for hiring decisions.

You are not required to furnish any information that is prohibited by federal, state, or local law.

General Information

Last Name:	First Name:	M:	Date Of Birth:
Home Address:	City & State:		Zip Code:
Home Phone:	Cell Phone:		SSN:
Email:			Driver's License #:
Position Applying For:			Expiration Date:
			Issuing State:

Please check ALL hours that you are AVAILABLE and WILLING to work (all shift times are approximate):
1st Shift
2nd Shift
3rd Shift

What Location are you interested in?
Harrodsburg
Springfield
Bardstown
Louisville/Shelbyville/Shepherdsville
Lexington/Georgetown
Campbellsville
Other:

Employment History

Current or Last Employer:
Employer Address:
Phone:	Type of Business:
Your Position:	Employed From: to
Type of Work:	Starting Wage: Final Wage:
What do/did you like about this job?
What do/did you dislike about this job?
Reasons you desire(d) a change in employment:
May we contact your previous employer? Contact:

Next Previous Employer:
Employer Address:
Phone:	Type of Business:
Your Position:	Employed From: to
Type of Work:	Starting Wage: Final Wage:
What do/did you like about this job?
What do/did you dislike about this job?
Reasons you desire(d) a change in employment:
May we contact your previous employer? Contact:

Education

Name of High School:		Location:
Name of College:		Location:

Other

Your salary expectations?

Do you have the legal right to work for any employer in the United States? Yes No

Do you have the legal right to work in Canada and Mexico? Yes No

Have you ever been convicted of a crime (other than a minor traffic violation)? Yes No
If so, please explain:

Do you give PRO TECH the right to require you to take a drug test at any time? Yes No

Are there any challenges that you face (in or out of the workplace) that you would like us to be aware of? Yes No
If so, please explain:

Have you ever been employed by PRO TECH in the past? Yes No
If yes, list date(s) and position(s):

Is your Driver's License valid, and can you legally drive? Yes No

What date are you available to begin work?

Pro Tech has client locations throughout the area, and you are expected to drive to our clients' sites for your work assignment. Can you personally drive to these locations, without relying upon others? Yes No

Occasionally, you may be asked to drive over 60 miles to a client's location, and you will be paid additional compensation for your Drive Time. Are you willing to accept this type of assignment? Yes No

Are you willing to accept overnight work assignments, including paid hotel? Yes No

After completion of your training as a Quality Inspector, you may be required to work a shift that is longer than 8 hours. Are you willing to accept such an assignment? Yes No

Type of employment desired: Full Time Part Time Seasonal Temporary Co-op

How were you referred to Pro Tech? Friend Newspaper Internet Television
Please specify the name of the source:

If Under 18 Years of Age Only
Can you provide a Work Permit? Yes No
If No, please explain:

Do you give Pro Tech consent to run a background check for employment purposes? Yes No

References

(Please list three persons not related to you, whom you have known at least one year)

REFERENCE 1
Name:
Address:
Phone:
Occupation:
Relationship:
Years Known:

REFERENCE 2
Name:
Address:
Phone:
Occupation:
Relationship:
Years Known:

REFERENCE 3
Name:
Address:
Phone:
Occupation:
Relationship:
Years Known:

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DRUG TEST CONSENT

CONSENT FOR PRE-EMPLOYMENT, RANDOM, OR REASONABLE SUSPICION DRUG TEST SCREEN AND RELEASE COVENANT NOT TO SUE AND INDEMNITY AGREEMENT

I hereby consent to allow Pro Tech Quality Solutions LLC (PRO TECH), Inc. to take a specimen of my hair, urine or blood at any time for drug test screening. I further consent to allow the laboratory testing service to make the results of such screening available to Pro Tech Quality Solutions LLC (PRO TECH), Inc.

I also release the laboratory testing service, its officers, agents, and employees, from any and all claims which I might otherwise have due to such results being made so available; and, I hereby consent not to file any action at law or in equity against Pro Tech Quality Solutions LLC (PRO TECH), Inc., the laboratory testing service, their respective officers, agents, or employees in connection with the results of such screen being made so available, and I hereby agree to indemnify and save harmless Pro Tech Quality Solutions LLC (PRO TECH), Inc., the laboratory testing service, their respective officers, agents, and employees from all damages, expenses, reasonable attorney's fees, and costs of court which they or any of them may suffer or incur, jointly or severally, due to the results of such screening being made so available.

ACKNOWLEDGEMENT & RELEASE

I certify that the answers given in this application for employment are true and complete to the best of my knowledge. I have provided requested information about all my previous jobs, and authorize investigation into all statements I have made on this form as may be necessary for reaching an employment decision.

In the event I am employed by Pro Tech Quality Solutions LLC, I understand that any false or misleading information that I knowingly provide in this application for employment or interview(s) may result in discharge or legal action. I also understand that if employed, I will be contacted for work as it becomes available, and that I am guaranteed neither a minimum nor maximum number of hours per week. I am also required to abide by all rules and regulations as set forth by Pro Tech Quality Solutions LLC (PRO TECH), Inc. and any special agreements reached between PRO TECH and I.

PLEASE READ AND SIGN THE FOLLOWING

In consideration of my employment, I agree to conform to the rules and regulations of PRO TECH, and I understand that my employment may be terminated at any time by me or PRO TECH with or without notice, for any reason. I understand that no Manager, or any other employee or representative of PRO TECH other than the President of PRO TECH, has the authority to enter into any agreement for employment for any specified period of time, or to make any agreement contrary to the foregoing.

Employees and former employees are prohibited from releasing to any other party any information whatsoever about PRO TECH which is of a confidential nature or which could be deemed to constitute a “trade secret.” Employees or former employees are further prohibited from using, in any manner whatsoever, information which is confidential, proprietary, or privileged, whether for their personal benefit or gain, or for that of any other person. Any information which has not been disclosed publicly in writing should be treated as confidential and proprietary.

I understand the duties, including physical requirements, of the position for which I am applying with PRO TECH and I certify that I am capable of performing the required tasks with or without reasonable accommodation. If after I am hired I am requested to perform work which I am unable to perform due to a disability, I will notify PRO TECH management so that we may discuss the options for reasonable accommodation.

I understand that PRO TECH does not tolerate racial or sexual harassment or discrimination, and I understand that I should report any actual racial or sexual harassment or discrimination to PRO TECH management, and that I am protected against retaliation for having done so.

RELEASE OF CLAIMS AGAINST PRO TECH CUSTOMERS

I understand that I am applying for temporary work assignments with PRO TECH, and that PRO TECH provides temporary workers for its customers to work at the customers' project sites. In accepting any work assignment, I acknowledge that I am not an employee of PRO TECH's customer.

If I am ever injured in the course of my work for PRO TECH, I agree that I will look only to PRO TECH's Workers' Compensation coverage and not to PRO TECH's customer for any recovery. For myself, and on behalf of my heirs, executor, personal representative and assigns, I waive, release and forever discharge any claim that I may now have or that may later accrue against any customer of PRO TECH which directly or indirectly arises out of any injuries which may occur to me while on a temporary work assignment for PRO TECH.

In signing this release, I understand that I am not waiving or releasing any claims which I may have against the Worker's Compensation coverage provided by PRO TECH.

JOB ASSIGNMENT & DISPATCH

I understand that there may be periods during which PRO TECH may not require me to work on a particular day (or days), and I acknowledge that PRO TECH is not required to find work for me and that I will only be contacted for work as it becomes available.

I understand that PRO TECH is committed to dispatching employees on a seniority basis, but when necessary follows a "best match for dispatch" policy, in which case the company dispatches a specific employee or employees requested by a customer, or dispatches an employee or employees with a known skill or specialized training. I understand that after receiving a job assignment, I am free on my own time to do as I wish until the job assignment starts. I understand the importance of never being late for a job assignment.

If I am assigned to an ongoing job, (defined as a request to return to the same job on the following workday or at a later date), I know that I am required to notify PRO TECH dispatch at least 3 hours before the next day's reporting time if I am unavailable to report for work that day. PRO TECH reserves the right to return me to that assignment or replace me permanently, based on business need. If I do not report for work, or respond to calls for work for two consecutive days, I will be considered to have voluntarily quit.