Employment Application

If you are applying for a position where driving is a requirement of the job, please answer the following questions.

Please list two professional references.

Premier Scaffold, Inc., prohibits discrimination against or harassment of any person employed by or seeking employment with Premier Scaffold, Inc., on the basis of race, color, national origin, religion, sex, physical or mental disability, medical condition (cancer-related or genetic characteristics), ancestry, marital status, age, sexual orientation, citizenship, or protected veteran status. Premier Scaffold, Inc., is an affirmative action/EOE including disability and veterans.

Why Are You Being Asked to Complete This Form?
This employer is a Government contractor subject to the Vietnam Era Veterans’ Readjustment Assistance Act of 1974, as amended by the Jobs for Veterans Act of 2002, 38 U.S.C. 4212 (VEVRAA). VEVRAA requires Government contractors to take affirmative action to employ and advance in employment protected veterans. To help us measure the effectiveness of our outreach and recruitment efforts of veterans, we are asking you to tell us if you are a veteran covered by VEVRAA. Completing this form is completely voluntary, but we hope you fill it out. Any answer you give will be kept private and will not be used against you in any way. For more information about this form or the equal employment obligations of Federal contractors, visit the U.S. Department of Labor’s Office of Federal Contract Compliance Programs (OFCCP) website at www.dol.gov/ofccp.

How Do You Know if You Are a Veteran Protected by VEVRAA?
Contrary to the name, VEVRAA does not just cover Vietnam Era veterans. It covers several categories of veterans from World War II, the Korean conflict, the Vietnam era, and the Persian Gulf War which is defined as occurring from August 2, 1990 to the present. If you believe you belong to any of the categories of protected veterans please indicate by checking the appropriate box below. The categories are defined on the next page and explained further in an Am I a Protected Veteran? infographic provided by OFCCP. (https://www.dol.gov/sites/dolgov/files/ofccp/posters/Infographics/files/ProtectedVet- 2016-11x17_ENGESQA508c.pdf)

What Categories of Veterans Are “Protected” by VEVRAA? “Protected” veterans include the following categories: (1) disabled veterans; (2) recently separated veterans; (3) active duty wartime or campaign badge veterans; and (4) Armed Forces service medal veterans. These categories are defined below. 1. A “disabled veteran” is one of the following: a. a veteran of the U.S. military, ground, naval or air service who is entitled to compensation (or who but for the receipt of military retired pay would be entitled to compensation) under laws administered by the Secretary of Veterans Affairs; b. or a person who was discharged or released from active duty because of a service-connected disability. 2. A “recently separated veteran” means any veteran during the three years beginning on the date of the veteran’s discharge or release from active duty in the U.S. military, ground, naval, or air service. 3. An“activedutywartimeorcampaignbadgeveteran”meansaveteranwho served on active duty in the U.S. military, ground, naval or air service during a war, or in a campaign or expedition for which a campaign badge has been authorized under the laws administered by the Department of Defense. 4. An “Armed forces service medal veteran” means a veteran who, while serving on active duty in the U.S. military, ground, naval or air service, participated in a United States military operation for which an Armed Forces service medal was awarded pursuant to Executive Order 12985.

Why are you being asked to complete this form?
Because we do business with the government, we must reach out to, hire, and provide equal opportunity to i qualified people with disabilities. To help us measure how well we are doing, we are asking you to tell us if you have a disability or if you ever had a disability. Completing this form is voluntary, but we hope that you will choose to fill it out. If you are applying for a job, any answer you give will be kept private and will not be used against you in any way. If you already work for us, your answer will not be used against you in any way. Because a person may become disabled at any time, we are required to ask all of our employees to update their information every five years. You may voluntarily self-identify as having a disability on this form without fear of any punishment because you did not identify as having a disability earlier.

How do I know if I have a disability?
You are considered to have a disability if you have a physical or mental impairment or medical condition that substantially limits a major life activity, or if you have a history or condition. Disabilities include, but are not limited to: record of such an impairment or medical Post-traumatic stress disorder (PTSD) Obsessive compulsive disorder Impairments requiring the use of a wheelchair Intellectual disability (previously called mental retardation) Blindness Deafness Cancer Diabetes Epilepsy Autism Cerebral palsy HIV/AIDS Schizophrenia Muscular dystrophy Bipolar disorder Major depression Multiple sclerosis (MS) Missing limbs or partially missing limbs.

Federal law requires employers to provide reasonable accommodation to qualified individuals with disabilities. Please tell us if you require a reasonable accommodation to apply for a job or to perform your job. Examples of reasonable accommodation include making a change to the application process or work procedures, providing documents in an alternate format, using a sign language interpreter, or using specialized equipment. i Section 503 of the Rehabilitation Act of 1973, as amended. For more information about this form or the equal employment obligations of Federal contractors, visit the U.S. Department of Labor’s Office of Federal Contract Compliance Programs (OFCCP) website at www.dol.gov/ofccp. PUBLIC BURDEN STATEMENT: According to the Paperwork Reduction Act of 1995 no persons are required to respond to a collection of information unless such collection displays a valid OMB control number. This survey should take about 5 minutes to complete.

I certify that I have completed this application and the statements I have made in this application are true and complete. I understand that any falsified statements on this application or omission of fact either on this application or during a pre-employment process will result in my application being rejected, or, if I am hired, in my employment terminated with cause. If I become employed, in consideration of my employment, I understand that I must comply with the rules, regulations, policies and procedures of the company. I am aware of and understand the physical requirements of the job and certify that I can and will perform these requirements in a safe manner, with or without accommodation. In accordance with the Immigration and Control Act of 1986 Premier Scaffold, Inc., will only hire United States citizens and aliens lawfully authorized to work in the United States. This employer participates in E-Verify and will provide the federal government with your Form I-9 information to confirm that you are authorized to work in the U.S. I understand that I will be required to complete the designated employment eligibility verification I-9 Form as a condition of employment. I understand that I may be required to undergo drug testing and/or a criminal background check and that my employment is contingent upon these results. I understand and agree that if I am employed as a result of this application, my employment will be at at-will, which I understand means that I will not be employed for any definite period of time and that my employment may be terminated at any time. At-will employment may only be modified by written agreement signed by an Officer of the Company.