Application for Employment

Safetyone Training Inc.
8181 W. Brandon Dr.
Littleton, CO 80125

This is an application for employment with Safetyone Training Inc. Employment is at will and may be terminated at any time for any reason by either the employer or employee. “Submission of an application does not guarantee a job interview”.

All questions must be answered carefully and completely. Please TYPE or PRINT clearly. This application must be completed and signed personally by the applicant. If any information is missing, your application may be rejected. If an answer is NO or NONE, indicate the same. We appreciate your interest in our company

Safetyone Training Inc. is an equal employment opportunity employer and will not discriminate against any applicant or employee on any grounds protected under federal, state, or local law. Those applicants requiring reasonable accommodation in the application and/or interview process should notify a representative of the Human Resources Department.

Name*

First Middle Last

Have you worked under any name(s)? If so, please indicate here:

Permanent Address*

Street Address Address Line 2 City State ZIP Code

Email*

Telephone Number*

How did you hear about us?*

Previous Addresses

Please include previous temporary and permanent addresses covering the last ten (10) years. Use text area below if necessary.

Additional Addresses

Are you 18 years or older?*

Yes
No

Are you employed now?*

Yes
No

If so, may we contact your present employer for:

A Reference
Employment Verification (dates of employment and titles held)

Position Sought:*

Rate of pay expected:*

Are you able to perform all of the essential functions of the position for which you are applying with or without reasonable accommodation?*

Yes
No

Other position(s) qualified for:

If hired, can you furnish proof that you are eligible to work in the United States?*

Yes
No

Check the shift you can work:*

Full Time
Part Time
Day
Evening
Night

Special Licenses or Certifications:

Expiration Date:

Have you previously been convicted of a Felony or Misdemeanor: your answer should be “no” if such record has been sealed, there was a Youthful Offender adjudication, or such Conviction was reversed on appeal and dismissed.”*

Yes
No

Have you previously been employed by Safetyone Training Inc?*

Yes
No

Answer this question only if you are applying for position for which driving is an essential Function of the position. Do you have a valid driver’s license?

Yes
No

Professional Endorsements:

Education

Buckingham Manufacturing Company, Inc. takes into account education, other skills, as well as past job experience in determining the most qualified applicant for open positions.

What is your highest grade completed?*

High School

College

Other Graduate, Business or Vocational School, or Other Training Skills:

Military Service Branch

Years of Military Service:

Military Rank:

Employment Record
(List most recent first)

Name of Company:

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone

Dates of Employment

Type of Business:

Your Position/Title:

Supervisor/Contact Info:

May we contact for reference?

Yes
No

Reason for Leaving

Briefly Describe Your Duties and Responsibilities:

Name of Company:

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone

Dates of Employment

Type of Business:

Your Position/Title:

Supervisor/Contact Info:

May we contact for reference?

Yes
No

Reason for Leaving

Briefly Describe Your Duties and Responsibilities:

Name of Company:

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone

Dates of Employment

Type of Business:

Your Position/Title:

Supervisor/Contact Info:

May we contact for reference?

Yes
No

Reason for Leaving

Briefly Describe Your Duties and Responsibilities:

References

List three (3) references other than family or friends.

REFERRED BY:

REFERRAL DATE:

Reference #1

Name*

First Last

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone*

Occupation*

Reference #2

Name*

First Last

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone*

Occupation*

Years Known*

Reference #3

Name*

First Last

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone*

Occupation*

Years Known*

By my digital signature below, I affirm that the information provided in this employment application (and in any related documents or interview) is true and complete. I understand that any false or misleading information or significant omissions may disqualify me from further consideration for employment, and may lead to my dismissal from employment, if discovered later.

“Submission of an application does not guarantee a job interview”. I understand that if I receive a conditional offer of employment, I will be required to successfully complete a pre-employment physical, substance abuse screening and background investigation prior to beginning work. Furthermore, Safetyone Training Inc may conduct random substance abuse screening at its discretion. I agree to submit to such testing if required.

I expressly authorize investigation by Safetyone Training Inc., its agents and representatives of all statements, references, and information provided in this application (or in any related documents or interview). Such investigation may include but is not limited to my express authorization for Safetyone Training Inc. to contact any person, school, current or prior employer named in this form (or in any related documents or interview) in connection with my application unless I have specifically excluded my permission to contact the same.

I understand that this application does not create a contract for employment. I understand that, if hired, I am obliged to comply with all current and subsequently adopted company policies. I understand and agree that, if hired, my employment is for no definite period and may be terminated at any time, at the will of either party with or without cause and with or without prior notice.

Date*

Signature of Applicant*

First Last

Application for Employment

Safetyone Training Inc.8181 W. Brandon Dr.Littleton, CO 80125

Previous Addresses

Education

Employment Record(List most recent first)

References

Reference #1

Reference #2

Reference #3

Safetyone Training Inc.
8181 W. Brandon Dr.
Littleton, CO 80125

Employment Record
(List most recent first)