Employment Application

The Melanson Company and Affiliates
Application for Employment

The Melanson Company and its’ affiliates (“Company”) are Equal Employment Opportunity Employers and do not discriminate on the basis of race, color, religion, sex, sexual orientation, gender identity, age, national origin, disability or veteran status. The companies make reasonable accommodations for qualified individuals with disabilities in accordance with the Americans with Disabilities Act and applicable laws. Applicants requiring reasonable accommodation in the application process should notify the location manager.

Applying for:

1. Personal Information

All statements and questions are to be completed; the answers will be confidential.

First
Last
Address
City
State/Province
Zip/Postal
Are you legally entitled to work in the United States*?
(*Proof of eligibility will be required upon offer of employment)
Do you have a valid Driver’s License?
If yes, do you have a commercial license*?
Have you ever been convicted of, or have you pleaded guilty to, a felony or misdemeanor (excluding minor traffic offenses or convictions that have been sealed or expunged)?
(Applicant, please note that a conviction of a crime is not an automatic bar to employment. All circumstances will be considered)

2. Employment Desired

If you are presently employed, may we contact employer?
Have you ever been employed by our company or its affiliates before?
If Yes, please complete the following:

3. Previous Employment & Experience

Please list all former employers, beginning with the most recent. Do not exclude any employment. Include any applicable temporary employment. (Attach another sheet if necessary.)

1

2

3

4. Personal References

Please list the names of THREE people you have known for at least ONE YEAR who are not related to you.

1

2

3

5. APPLICANT ACKNOWLEDGEMENT AND AUTHORIZATION

*PLEASE READ CAREFULLY BEFORE SIGNING*

If employed, I agree to engage in no outside activity which would involve a material conflict of interest with, or which could reflect adversely on the Company. I understand this decision is to rest with the Company. I understand that due to the nature of the Company’s business, attendance and punctuality are considered essential requirements of every job at the Melanson
Company. I understand that my employment is “at-will” which means I can be terminated, with or without cause, at any time, at the option of the Company. I understand that no statements, assurances, policies, procedures, or actions of the Company or its representatives used during the employment process is deemed a contract of employment, wither real or implied. I understand that no representative of the Company, except the President, has the authority to enter into any agreement guaranteeing any conditions of employment or any agreement contrary to the foregoing statements and that any such agreements must be made in writing and signed by the President. The Company may, at its sole discretion, revoke, amend, suspend, abridge, or change any benefit, policy, procedure, practice, condition or process affecting employees or my employment. I also understand that any aspect of my employment including but not limited to my hours, duties, rate of pay, location of work, and benefits can be changed or eliminated at the company’s sole discretion unless restricted by law.

Descriptions of these that are contained in any handbook, manual, policy and the like are for informational purposes and are not intended to be, nor should they be considered to constitute any employment contract, or an offer of continuing employment, benefit, or promise or any guarantee made by the Company.

I hereby affirm that my answers to these statements and questions (or any other accompanying or required documents) are true, correct, and complete to the best of my knowledge. I have not knowingly withheld any fact or circumstance that would, if
disclosed, affect my application unfavorably. I understand that any misrepresentation, deception, false statement or omission of any facts made in this Application for Employment (and/or accompanying documents) will result in my not being considered
for employment, and if not discovered by the Company until after my becoming employed, will result in immediate termination of employment, regardless of the timing or circumstances of discovery. I further understand that if my employment with the Company may be restricted by any contract or agreement I have entered into, I will so advise the
Company.

THE MELANSON COMPANY IS PROUD TO BE AN EQUAL OPPORTUNITY EMPLOYER. ALL QUALIFIED APPLICANTS WILL RECEIVE CONSIDERATION WITHOUT REGARD TO RACE, COLOR, RELIGION, GENDER, NATIONAL ORIGIN, AGE, DISABILITY, VETERAN STATUS OR ANY OTHER STATUS PROTECTED BY LAW. ANY APPLICANT WHO NEEDS REASONABLE ACCOMMODATION IN THE APPLICATION OR EMPLOYMENT PROCESS SHOULD NOTIFY DAVID P. THERRIEN.

BY SIGNING BELOW, I ACKNOWLEDGE THAT I HAVE READ, UNDERSTAND AND AGREE TO THE TERMS AS OUTLINED ABOVE.

FOR OFFICE USE ONLY

Hired?

EOE/M/F/Vet/Disability Employer

Name
Name
First Name
Last Name