(If applying for Driver Position, complete Commercial Driver/CDL Holder Employment Application
Supplement)
Shamrock Environmental Corporation
APPLICATION FOR
EMPLOYMENT
AN EQUAL OPPORTUNITY EMPLOYER
SEC appreciates your interest and assures you that your application will be given careful consideration. Please answer all
questions fully and accurately. Filing this application does not indicate that there are any positions open, and does not in any
way obligate SEC, its Divisions and/or its Subsidiary Companies.
PLEASE PRINT
NAME (In Full) Last First Middle TELEPHONE NO:
PRESENT ADDRESS House # and Street City State Zip HOW LONG HAVE YOU LIVED THERE?
SOCIAL SECURITY NO. ARE YOU AT LEAST 18 OR OVER? HAVE YOU EVER BEEN KNOW BY A DIFFERENT NAME?
O YES O NO O YES (specify) O NO
HOW DID YOU HEAR ABOUT SEC?
HAVE YOU EVER BEEN EMPLOYED BY THIS COMPANY? IF YES, WHEN ? WHERE ?
O YES O NO
WHAT POSITION ARE YOU APPLYING FOR?
ARE YOU APPLYING FOR ARE YOU AVAILABLE FOR
O FULL-TIME O PART TIME O DAYWORK O EVENING WORK O EITHER
CIRCLE DAYS OF THE WEEK YOU ARE AVAILABLE ARE THERE ANY HOURS DURING WHICH YOU CANNOT WORK?
SUN M T W TH F SAT LIST:
IN CASE OF EMERGENCY NOTIFY NAME ADDRESS PHONE NO.
Have you, after reaching 18, ever been convicted of any crime other than traffic violations? O YES O NO
If yes, give full explanation of each case including date, place, charge & outcome. Attach additional sheet if necessary
DATE PLACE CHARGE OUTCOME
You will not be eliminated from consideration unless a conviction is determined to have a direct bearing on the duties you will perform
Are you Legally permitted to work in the United States? O YES O NO
RECORD OF EDUCATION
CIRCLE HIGHEST
SCHOOL NAME AND ADDRESS OF SCHOOL GRADE COMPLETED
GRADE SCHOOL 1 2 3 4 5 6 7 8
HIGH SCHOOL 9 10 11 12
COLLEGE, VOCATIONAL 1 2 3 4
BUSINESS SCHOOL
GRADUATE SCHOOL 1 2 3 4
SEC may be required to complete a background check. As a condition of consideration for employment,
you must furnish the following information. LEAVE NO AREAS BLANK - AND BE SURE TO LIST
PEOPLE WE WILL BE ABLE TO CONTACT TO VERIFY THE INFORMATION. Attach additional sheet if
necessary to give us a complete five year background.
PREVIOUS WORK EXPERIENCE Office Use Only
FROM MO. YR. NAME OF COMPANY AND ADDRESS SUPERVISOR REASON FOR LEAVING CONTACTED
BY/DATE
TO PHONE
( )
TYPE OF WORK PERFORMED
FOR OFFICE USE ONLY :
FROM MO. YR NAME OF COMPANY AND ADDRESS SUPERVISOR REASON FOR LEAVING CONTACTED
BY/DATE
TO PHONE
( )
TYPE OF WORK PERFORMED
FOR OFFICE USE ONLY :
FROM MO. YR NAME OF COMPANY AND ADDRESS SUPERVISOR REASON FOR LEAVING CONTACTED
BY/DATE
TO PHONE
( )
TYPE OF WORK PERFORMED
FOR OFFICE USE ONLY:
FROM MO. YR. NAME OF COMPANY AND ADDRESS SUPERVISOR REASON FOR LEAVING CONTACTED
BY/DATE
TO PHONE
( )
TYPE OF WORK PERFORMED
FOR OFFICE USE ONLY:
FROM MO. YR. NAME OF COMPANY AND ADDRESS SUPERVISOR REASON FOR LEAVING CONTACTED
BY/DATE
TO PHONE
( )
)
TYPE OF WORK PERFORMED
FOR OFFICE USE ONLY:
PLEASE EXPLAIN ANY LAPSES IN TIME BETWEEN JOBS:
FROM: REASON:
TO:
FROM: REASON:
TO:
BACKGROUND CHECK
PERSONAL REFERENCES
As a part of our employee background check, you must furnish SEC with the following
Information for at least 3 personal references who have known you at least 5 years each.
THESE MUST BE PEOPLE WE ARE ABLE TO CONTACT TO VERIFY YOUR RELATIONSHIP
TO THEM. IF THESE INDIVIDUALS CANNOT BE LOCATED OR CONTACTED TO VERIFY
YOUR REFERENCE, YOU MAY BE DENIED A POSITION WITH SEC.
PERSONAL REFERENCES (Not former employers or relatives) FOR O FFICE USE ONLY
NEED THREE REFERENCES WHO H A VE KNOWN YOU FOR AT L E AS T THE LAST F I VE Y EA R S
NAME OCCUPATION PHONE (AREA CODE) PERSON CONTACTED
BY/DATE
ADDRESS
FOR OFFICE USE ONLY
NAME OCCUPATION PHONE (AREA CODE) PERSON CONTACTED
BY/OATE
ADDRESS
FOR OFFICE USE ONLY
NAME OCCUPATION PHONE (AREA CODE) PERSON CONTACTED
BY/DATE
ADDRESS
FOR OFFICE USE ONLY
U.S. MILITARY BACKGROUND
DATES MO. YR . MO YR. RANK ON DISCHARGE TYPE OF DISCHARGE
FROM / TO /
CAN YOU PROVIDE A COPY OF FORM DD214 UPON REQUEST? O YES O NO
BRANCH OF SERVICE DUTIES/MOS:
THIS CERTIFIES THAT, IF REQUESTED, A COMPLETE BACKGROUND CHECK WAS
SUCCESSFULLY COMPLETED ON THE FOLLOWING INDIVIDUAL.
NAME _____________________________________________________________________________
SOCIAL SECURITY NUMBER __________________________________________________________
ALL OTHER REQUIRED INFORMATION AND FORMS HAVE BEEN FORWARDED
TO THE CORPORATE OFFICE.
COMPLETED BY ___________________________________________ DATE ___________________
CONSENT
I understand that Shamrock Environmental Corporation and its affiliates, in
accordance with Federal Department of Transportation Regulations (49 CFR Part 40), has
established a Substance Abuse Prevention Program implementing those Regulations. In
addition, the Company has implemented a Drug Free Workplace Policy for all employees.
Compliance with these programs is a required condition of employment,
The Federal Regulations specify that all persons applying for certain specified
safety sensitive positions must be drug free to work in those positions, and must
accordingly pass a pre-employment drug test for cannabinoids (marijuana), cocaine,
phencyclidine (PCP), amphetamines, and opiates to determine whether or not they are
drug free.
I further understand that applicants for such positions who successfully pass the
pre-employment drug test, and are in fact employed by S h a m r o c k i n specified safety
sensitive positions covered by the Federal Regulations, will be subject to and must pass
additional drug testing of drugs specified by the Federal Regulations as a condition for
employment thereafter. This additional drug testing will include reasonable cause,
random, post-accident, and after rehabilitation drug tests, as specified in the Federal
Regulations.
In recognition of the above, I hereby give my unconditional consent to be drug
tested, and agree to provide the required urine sample as specified by the Federal
Regulation for the purpose of accomplishing the drug-testing requirement outlined
above.
If employed by Shamrock, I further agree to submit to the additional drug testing
outlined above, and understand that I must pass such drug test and be drug free as a
condition of employment. I realize that failure to remain drug free or submit to the
required drug testing will result in my immediate termination.
Name (Please Print) ___________________________________________________________
Social Security # _____________________________________________________________
Signature ________________________________________Date_______________________
Copy to Personnel File
SEC RULES AND REGULATIONS
PLEASE READ THE FOLLOWING RULES CAREFULLY
(Failure to comply could result in disciplinary action up to and including discharge)
1. Employees must report to their work assignment in time in proper uniform, and must comply with all company grooming policies.
Employees are required to clock in and out (some locations require the use of sign in/out sheets). No one is permitted to clock
2.
(sign) in/out for anyone else.
If you are going to be late/absent, you are required to give your supervisor at least four hours notice to arrange for proper
3
coverage. Failure to notify the office of an absence will be cause for immediate dismissal.
Employees must wear designated uniforms in the performance of their work assignment for Shamrock only and not for personal
4.
use.
Employees must wear safety equipment as required, and will observe standard safety practices at all times while in the
5.
performance of their duties.
6. Employees are not permitted to leave their assigned work area without the permission of their supervisor.
7. Using the property of Shamrock customers or Shamrock without prior authorization is forbidden and will be grounds for dismissal.
Reporting to work under the influence of drugs or alcohol, or the use of drugs or alcohol while on duty will be cause for
8.
termination.
Carrying a concealed weapon, horseplay, gambling, fighting, theft, or bringing discredit to the company and/or its customers is
9.
not permitted.
Discussions or interviews with representatives of the media (either print or broadcast) that impact the image of Shamrock or its
10.
customers is not permitted without prior knowledge and consent of Shamrock management. Such discussions or interviews will
be grounds for disciplinary action up to and including termination.
Employees must report any injuries sustained on the job, regardless of how minor, immediately to their supervisor. Failure to
11.
properly report any injury may result in disqualification of company benefits. If medical attention is needed, you will be taken to a
doctor. Any employee consulting a doctor for treatment for a job-connected injury must obtain a doctor's release before returning
to work. Any employee absent from work five days or more due to any injury or illness must obtain a doctor's release to return.
12. Employees are instructed to report any damage, breakage, customer complaint, or other problem related to their work
IMMEDIATELY to their supervisor, in writing.
13 Children, relatives, friends or any other unauthorized person may not be with you under any circumstances, while on duty.
Any employee contacting Shamrock clients without written permission from his or her supervisor will be subject to immediate
14.
dismissal.
15. Failure to abide by Company Substance Abuse Prevention Program will be grounds for IMMEDIATE TERMINATION.
16. Shamrock employees agree as a condition of employment to an implicit non-compete clause, i.e. not to disclose, divulge or
otherwise entrust any privileged information concerning Shamrock, its programs or clients, to any other party which would be
in a position to benefit in any way from such information.
I agree that any false statement in this application shall be sufficient cause for rejection or dismissal. I hereby grant permission to
investigate any of the information included in this application and to submit to a drug test, if required. If employed, I will abide by the
rules of the Company and any rules and regulations that become effective while I am employed. I certify that I have read or have had
read to me and fully understand the Company rules and regulations.
All qualified applications will receive equal consideration without regard to race, age, color, religion, national origin, sex, disability,
pregnancy, veteran status or any other group protected by federal, state or local law.
APPLICANT SIGNATURE WITNESS DATE
FAIR CREDIT REPORTING ACT DISCLOSURE STATEMENT
In accordance with the provisions of §604(b)(2)(A) of the Fair Credit Reporting Act (FCRA), you are
being informed that reports verifying your previous employment, previous drug and alcohol test
results, criminal history, driving record and/or credit history may be obtained on you for employment
purposes. The information included in these reports is required to meet the security and loss control
requirements of Shamrock Environmental Corporation and its clients as well as the Federal Motor
Carrier Safety Regulations, Pipeline Safety Regulations (Research and Special Programs
Administration) and/or other applicable and relevant regulations and requirements.
To: Shamrock Environmental Corporation:
I hereby authorize and request any present or former employer, school, police department, financial
institution, agency or other persons having knowledge about me, to furnish bearer with any and all
information in their possession regarding me, in connection with an application for employment or
ongoing continuation of current employment. This includes but is not limited to obtaining consumer
report information that may include motor vehicle records, criminal background checks, and
employment history. I am willing that a photocopy and/or electronic copy of this authorization be
accepted with the same authority as the original, and I specifically waive any requirement for written
notice from any specific information provider who may provide information based upon this authorized
request. I understand this authorization is to be part of my written employment application.
Furthermore, I understand that I am entitled to a copy of this form if requested.
Applicant’s Signature Date
Printed Name Social Security Number
Date of Birth (for identification purposes):
Driver’s License Information (for identification purposes):
License Number State Exp. Date
If name changed (through marriage or otherwise) print former name here:
Note to Consumer/Applicant: A copy of any consumer report obtained by Shamrock Environmental
Corporation that results in adverse action in an employment decision will be provided to you along with
a written description of the consumer’s rights under the FCRA. You may also obtain a photocopy of any
consumer report obtained by Shamrock Environmental Corporation under the FCRA as related to this
disclosure by providing timely, written request.
