CLARIDAN CONTRACTING, INC. EMPLOYMENT APPLICATION

Our company (“Claridan Contracting, Inc.”) fully subscribes to the principles of Equal Employment Opportunity. It is our policy to provide employment, compensation, and other benefits related to employment based on qualifications, without regard to race, color, religion, national origin, age, sex, veteran status, genetic information, disability, or any other basis prohibited by federal, state or local law. In accordance with requirements of the Americans with Disabilities Act and applicable federal, state and/or local laws, it is our policy to provide reasonable accommodation upon request during the application process to applicants in order that they may be given a full and fair opportunity to be considered for employment. As an Equal Opportunity Employer, we intend to comply fully with applicable federal, state and/or local employment laws and the information requested on this application will only be used for purposes consistent with those laws. To the extent required by applicable law, The Company maintains a smoke- free workplace.

Email Address:

Position Applied For:

PERSONAL DATA

Salary Expectations:

Name:

First Name

Last Name

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone

(###)

###

####

Are there any days, shifts or hours you will not work?

Yes

If yes, please explain:

How did you learn about our Company?

Have you ever applied to work at our Company before?

Yes

If yes, provide dates:

Are you legally authorized to work in the United States?

Yes

Will you now or in the future require sponsorship for employment visa status (e.g.,H-1B visa status)?

Note: The Federal Immigration and Reform and Control Act of 1986 requires that a DHS Employment Eligibility Verification "Form I-9" be completed for every new hire and that within 3 business days of beginning work every new hire must present to the employer documentation establishing his/her identity and authorization to work. This federal requirement must be satisfied as a condition of employment.

Yes

DRIVING RECORD

Do you have a valid driver's license?

(Answer only if driving is a requirement of the job for which you are applying).

Yes

State:

License No:

Have you had any tickets?

Yes

If yes, please explain:

EDUCATION

Describe any educational degrees, skills, training or experience you believe to be relevant to the job applied for:

High School - College - Technical/GED - Licenses/Certifications/Other Did you graduate? Degree received? Overall GPA?

EMPLOYMENT HISTORY

Please complete for a full-time or part-time employment beginning with the most recent employer. You may include as part of your employment history any verified work performed on a volunteer basis. All applicants should start with their most recent job, include military assignments and voluntary employment and provide ten (10) years of history. You must explain any gaps in your employment history.

Company Name:

Address:

Telephone:

(###)

###

####

Name of Supervisor:

May we contact?:

Yes

Dates Employed:

State job titles and describe job duties:

Reason for leaving:

Company Name:

Address

Telephone:

(###)

###

####

Name of Supervisor:

May we contact?:

Yes

Dates Employed:

State job titles and describe job duties:

Reason for leaving:

Company Name:

Address:

Telephone:

(###)

###

####

Name of Supervisor:

May we contact?:

Yes

Dates Employed:

State job titles and describe job duties:

Reason for leaving:

Have you ever been discharged or asked to resign from employment?

Yes

If yes, explain:

Did you receive any discipline in your last 12 months of active employment with your previous employer?

Yes

If yes, please explain:

Have you signed any non-competition or non-solicitation agreement or any other kind of agreement with any other employer that might restrict you from working for the Company (you will be required to furnish a copy of the agreement if you are being considered for hire)?

Yes

If yes, please explain:

PROFESSIONAL REFERENCES

Name:

Address:

Phone:

(###)

###

####

Relationship:

Name:

Address:

Phone:

(###)

###

####

Relationship:

MILITARY

(Complete only if you served in the military.)

Branch of Service:

Number of Years/ Months of Service:

Rank at Discharge:

Date of Discharge:

Describe any military skills, training or experience you belive are relevant to the job you applied for:

APPLICANT'S ACKNOWLEDGMENT

I certify that the answers given herein and during the entire application process (including but not limited to information provided in resumes, attachments to this application, interviews or otherwise (if applicable)) are true and complete to the best of my knowledge. I understand that any misrepresentations, omissions of facts or incomplete answers during the application process may disqualify me from further consideration for employment. I further understand that, if employed, any misrepresentations or omissions of facts during the application process may be cause for my dismissal at any time without prior notice. I consent to and authorize the Company to contact my former employers, references, and any and all other persons and organizations for information bearing upon my qualifications for employment. I further authorize the listed employers, schools and personal references to give the Company (without further notice to me) any and all information about my previous employment and education, along with any other pertinent information they may have and hereby waive any actions which I may have against either party(ies) for providing a good faith reference. I EXPRESSLY AGREE AND UNDERSTAND THAT, IF EMPLOYED, MY EMPLOYMENT IS NOT FOR A SPECIFIC TERM, IS BASED ON MUTUAL CONSENT AND MAY BE TERMINATED BY ME OR THE COMPANY WITH OR WITHOUT NOTICE OR CAUSE AT ANY TIME. I FURTHER UNDERSTAND THAT NO ORAL PROMISE, EMPLOYER POLICY, CUSTOM, BUSINESS PRACTICE OR OTHER PROCEDURE (INCLUDING PERSONNEL HANDBOOK OR ANY PERSONNEL MANUALS) CONSTITUTE AN EMPLOYMENT CONTRACT OR MODIFICATION OF THE AT-WILL EMPLOYMENT RELATIONSHIP BETWEEN ME AND THE COMPANY. I ALSO UNDERSTAND THAT MY AT-WILL EMPLOYMENT STATUS WITH THE COMPANY MAY ONLY BE ALTERED IN AN INDIVIDUAL CASE OR GENERALLY IN A WRITING SIGNED BY THE OWNER, PRESIDENT OR CEO OF THE COMPANY. I understand I may be required to qualify for employment based on additional employment criteria. For example, I may be required to take job-related tests; take a driver’s examination or take a preemployment drug test. If I am offered employment or start work before any required test is completed, I understand that my employment is contingent on a satisfactory result on all required tests. I authorize the release of any drug/alcohol test to any state or federal authority requesting such information and in response to a valid subpoena or other legal document. I agree to sign any additional forms necessary for drug tests to be conducted.

Electronic Signature (Your typed name will serve as your electronic signature)

Date

YYYY

We have received your application. To complete your submission please email your resume to hr@claridaninc.com.

If you are considered for an open position with the Company, someone will reach out to you with the next steps.

Thank you!

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