Main Office (601) 829-4100 info@bbecon.com

Application for Employment

Pre-Employment Questionnaire | An Equal-Opportunity Employer

Personal Information

Present Address

Permanent Address

Are you 18 years or older?YesNo

What foreign languages do you speak fluently?

Read?

Write?

Have you been convicted of a felony or misdemeanor in the past 5 years?YesNo

You will not be denied employment solely because of a conviction record, unless the offense is related to the job for which you have applied.


I have been advised that lie detector tests, as a condition of hiring or continued employment, are prohibited by law.

I have been advised that drug testing is required as a condition of hiring or continued employment.

Employment Desired

Are you employed now?YesNoIf so, may we contact your present employer?YesNo

Ever applied to this company before?YesNo

Education

Name and Location of School years attended Did you graduate? Subjects studied

Former Employers

List below last three employers, starting with last one first.

Date: Month /Year Name and Address of Employer Salary Postition Reason for leaving
START END

References

Give the names of three persons not related to you, whom you have known at least one year.

Name Address & Phone Number Business Years

Emergency Contact

I certify that the facts contained in this application are true and complete to the best of my knowledge and understand that, if employed, falsified statements on this application shall be grounds for dismissal. I authorize investigation of all statements contained herein and the references listed above to give you any and all information concerning my previous employment and any pertinent information they may have personal or otherwise, and release all parties from all liability for any damage that may result from furnishing same to you. I understand and agree that, if hired, my employment is for no definite period and may, regardless of the date of payment of my wages and salary, be terminated at any time without prior notice.

10/23/18



ALCOHOL AND DRUG ABUSE PROGRAM

B & B Electrical & Utility Contractors, Inc. has authorized and adopted the following rules, policies, and procedures in order to ensure safety, integrity, and general morale of the work place. Drug screening methods used are designed to detect the usage of ten types of drugs, marijuana, cocaine, opiates, amphetamines, phencyclidine (PCP), barbiturates, methadone benzodiazepines, propoxyphene, and methaqualone. The procedures set forth below are the best means of which B & B Electrical & Utility Contractors, Inc. is aware to ensure that testing is fair and accurate, thus protecting the integrity of test results and the privacy of individuals who are tested, all persons subject to this policy have been informed of it and are on notice of the contents of this policy.

Pre-Employment Screening

All prospective employees seeking to work for B & B Electrical & Utility Contractors, Inc. will submit to a pre-employment drug screen and/or alcohol test. No person will be allowed to perform any services for the company until the person has satisfactorily passed the pre-employment drug screening and/or alcohol test process. B & B Electrical & Utility Contractors, Inc. reserves the right to refuse to employ or utilize the services of any person whose screening or test results fail to satisfy the company. If an individual refuses to cooperate in the pre-employment screening or testing process, it will eliminate from consideration his or her application.

Reasonable Cause Testing

If a situation should arise which gives B & B Electrical & Utility Contractors, Inc. reasonable cause to suspect an employee of prohibited drug or alcohol use, the person under suspicion will make themselves immediately available for a drug or alcohol test.

Random Testing

In order to ensure that the objectives of the policy are met, B & B Electrical & Utility Contractors, Inc. will conduct drug or alcohol testing on a random basis. All employees will be subject to selection for testing without warning and at any time. Employees will be chosen totally random. Refusal to comply with the random drug screening or alcohol testing program will be cause for termination.

Effect of Positive Test

Any employee who refuses to submit to testing or who has a confirmed positive test result for any illegal substance under any aspect of B & B Electrical & Utility Contractors, Inc.’s Drug and Alcohol testing program will be terminated from employment. If any employee tests positive on other drugs for which the employee cannot produce a prescription, the employee will be verbally reprimanded with proper documentation put in their personnel file. The employee is to be notified that if this occurs again within a twelve (12) month period, he/she will be terminated. Any person applying for employment with B & B Electrical & Utility Contractors, Inc. who refuses to submit to testing or who test positive in a pre-employment drug screening or alcohol test will automatically be denied employment.

Confidentiality

Any individual who is subject to a drug or alcohol test under this policy will, upon written request, have access to any records relating to his or her drug or alcohol test.

Exception

From time to time B & B Electrical & Utility Contractors, Inc. sponsors social events where alcoholic beverages are served. Employees may consume alcoholic beverages at such events: however, they are expected to restrict the consumption of alcohol to a reasonable level, so as not to present a danger to themselves, other employees, the general public, or the reputation of the company.



ACKNOWLEDGEMENT OF NOTICE OF DRUG TESTING PROGRAM

I acknowledge receiving notice of the B & B Electrical & Utility Contractors, Inc.’s policy on alcohol and drug abuse including a description of the company’s drug and alcohol testing program. I understand that I may be required to submit to urinalysis or other forms of testing and that a confirmed positive test result of such testing or my refusal to submit to testing will result in dismissal. If I terminate my employment with B & B Electrical & Utility Contractors, Inc. on my own accord or if I am terminated for any disciplinary actions against me within the probation period of six months (180) days, I will reimburse B & B Electrical & Utility Contractors, Inc. sixty dollars ($60.00) for the cost of the initial drug screen.

I have read the company’s Alcohol and Drug Abuse Policy.

In consideration for my being considered for employment by B & B Electrical & Utility Contractors, Inc., I do hereby give my consent to B & B Electrical & Utility Contractors, Inc and to perform appropriate test or examinations necessary to determine the presence and/or level of drugs or alcohol in my body. I hereby give my permission to release the results of the tests or examinations to B & B Electrical & Utility Contractors, Inc.

I understand that my refusal to sign this form constitutes a violation of B & B Electrical & Utility Contractors, Inc.’s policy, and that for that refusal I will not be considered for, and knowingly waive my possibility for employment with B & B Electrical & Utility Contractors, Inc. A copy of this consent will be valid as an original.

10/23/18



CONSENT TO RELEASE RECORD(S) DRIVER SERVICES POLICY 6-9(A)

By signing below, I voluntarily give consent to the Mississippi Department of Public Safety to release the following record(s), including personal information within my driver license file. I request the record(s) indicated by my signature below to be released by the Department of Public Safety, their agents and employees, to the following person, company, corporation, or legal entity:

RELEASE RECORD/INFORMATION TO: B & B ELECTRICAL & UTILITY CONTRACTORS, INC.

MVR

Other Record (Specify)

10/23/18

NOTICE: As required by the Federal Driver Privacy Protection Act (DPPA), 18 U.S.C. Section 2721, the Mississippi Department of Public Safety will not release personal information from you driver record unless you consent by waiving your right to privacy under the DPPA; OR, unless the Department is required by DPPA to release personal information without your consent, such as in connection with matters of safety, theft, emissions, product alterations, recalls, advisories, certain federal laws; or unless the DPPA authorizes the Department to release it, such as to government entities, courts, insurance companies and to others specified.



SELF-IDENTIFICATION FORM

We as an employer wish to voluntarily comply with various laws and regulations, which require us to file annual statistical reports on applicants for employment. In addition, we wish to voluntarily comply with the various laws and regulations which protect the handicapped, disabled veterans and veterans who served on active duty during the Vietnam-era for more than 130 days. Submission of this information by you is voluntary. Please be assured that you will not be subjected to any adverse treatment if you do not provide this information requested.

Sex Classification EEO Classification

10/23/18