Employment Application

Thank you for your interest in applying for a job with Makotek. We need you to complete this application so we can determine whether or not to hire you. Please understand that our acceptance of this application does not create an obligation for us to hire you, not that you must work for us. Be advised that your application has certain legal consequences. Therefore, we advise you to read very carefully the "Applicants Acknowledgement" section at the end of this application BEFORE you answer the questions set forth.

Date:
What Position are you applying for?
What Location are you applying for?

Name:

Address:

City:

State:

Zip:

eMail:

Home Phone:

Work Phone:

Are you legally entitled to work in the United States? Yes No
Are you over 18 years of age? Yes No

Field Job Requirements Questionnaire (Dispatchers skip 1-12)

1. Is your work vehicle a reliable truck, van or SUV less than 10 years old and capable of carrying cargo and a 28' fiberglass ladder? Yes No
2. Are you able to lift and carry 75-90 pounds? Yes No
3. Are you able to work from heights and repeatedly climb a ladder? Yes No
4. Are you able to safely drive long distances and drive for extended periods? Yes No
5. Required hours include evenings up to 9:00 pm and Saturday. Are you able to work these hours? Yes No
6. Most fiberglass ladders have a weight limit of 300 lbs. After allowance for 20 lbs of tools, does your body weight meet the limit of 280 lbs? Yes No
7. Do you have a personal cell phone that can be used to receive customer callbacks? Yes No
8. Do you have a valid driver's license without restrictions? Yes No
9. Have you had your driver's license suspended within the past year for driving violations? Yes No
10. Have you been convicted of a felony in the past 7 years or are you currently on probation for any misdemeanor conviction? Yes No
11. Do you have current vehicle insurance with liability coverage? Yes No
12. It is the technician's responsibility to supply necessary field equipment. A complete tool list will be supplied. Certain items, such as a ladder, can be purchased from Makotek and reimbursed to Makotek over time through payroll deductions. Equipment that will not be available for purchase from Makotek includes a ladder rack for your vehicle. Is this a problem? Yes No
What days and hours of the week are you available to work? Be specific:

VEHICLE INFORMATION

Make:

Model:

Year:

Mileage:

Color:

LAST 3 EMPLOYERS

Company:

Position:

From:

To:

City, State Zip

Phone:

Salary:

Reason for Leaving:

Company:

Position:

From:

To:

City, State Zip

Phone:

Salary:

Reason for Leaving:

Company:

Position:

From:

To:

City, State Zip

Phone:

Salary:

Reason for Leaving:

SKILLS AND MISCELLANEOUS INFORMATION

Please list any additional experience, special skills and education:

APPLICANTS ACKNOWLEDGEMENT

IT IS VERY IMPORTANT THAT YOU READ THIS SECTION CAREFULLY, AND THAT YOU FULLY UNDERSTAND IT BEFORE YOU SIGN IT. THIS SECTION AFFECTS YOUR LEGAL RIGHTS. IF YOU HAVE ANY QUESTIONS REGARDING THOSE LEGAL RIGHTS, PLEASE ASK THEM BEFORE YOU SIGN THIS APPLICATION. IF YOU DO NOT ASK, WE WILL ASSUME THAT YOU FULLY UNDERSTAND THE LANGUAGE SET FORTH BELOW.

In exchange for Makotek's consideration of this employment application:

1. I understand that Makotek maintains a full and/or modified drug free workplace and that a policy is available for review upon request. I may be required to submit to a drug/alcohol test, under-go a post-job offer medical examination, or pencil and paper tests, designed to determine my suitability for the job for which I am bein considered. Additionally, from time to time, I may be required to take subsequent tests during the course of my employment and consent to such post-job offer and post-hire testing. I understand that, subject to applicable law, that Makotek shall be the sole judge of the acceptability of any test results.
2. I promise that all the information I have supplied in this application, and any other information, oral or written, is true and accurate. I understand that any misstated, misleading, incomplete, or false information is grounds for rejection of this application, refusal to hire, a withdrawal of an offer of employment, or immediate discharge without recourse, whenever and however discovered.
3. I hereby authorize Makotek, its agents or assigns, to contact my previous employers to request references. Further, I agree to hold Makotek and any such previous employer harmless for disclosure and authorize them to release any and all information pertaining to me and my employment.
4. I fully understand and acknowledge, and where applicable consent to, the following:
* That my employment is at will;
* That I may discharged for any reason, without notice;
* That I am subject to a 90-day introductory period;
* The Makotek may conduct a criminal background, a driver's license, and credit investigation and will check my references;
* That work schedules may vary and can be unpredictable, and that as such I may be required to work a different shift, weekends, or over time;
* That I will be required to comply with the policies and protocols set forth in the employee handbook of my employer;
* That Makotek reserves the right to amend, change, and/or modify the policies and protocols set forth in the employee handbook, with or without prior notice.

I HAVE READ AND FULLY UNDERSTOOD EVERYTHING ON THIS APPLICATION.

YES, I UNDERSTAND or NO, I DON'T UNDERSTAND

TYPE APPLICANT'S SIGNATURE:

DATE:

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