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Applicant Information

First Name

Middle Name(s)

Last Name

Please check this box to acknowledge that you have read our employer equal opportunity employer and at-will employer statement.

The Harver Company (the “Company”) is an equal opportunity employer that prohibits discrimination in hiring and terms and conditions of employment on the basis of race, sex, gender, pregnancy, child-birth or related medical condition, color, creed, religion, national origin, sexual orientation, gender identity, age, disability, military or veteran status, ethnicity, citizenship, genetic information, or any other legally recognized protected basis under local, state or federal law, regulations or ordinances.

Please check this box to acknowledge that you have read our employer equal opportunity employer and at-will employer statement.

Please check this box to acknowledge that you have read and understand our pre-employment drug screening requirement.

Drug testing is part of the Harver Company's pre-employment process and satisfactory completion of such tests is a prerequisite of employment for a safety sensitive position.

Please check this box to acknowledge that you have read and understand our pre-employment drug screening requirement.

Address

City

State

Zip

Mobile Phone

Phone

Other Phone

Phone

Region You Want to Work

Role Applying for

Date available to begin work

mm/dd/yyyy

Are you willing to travel?

Local Union #

Classification

Craft/Trade

Are you authorized to work in the U.S.?

Have you served in the military?

Are you able to perform the duties of the position?

Are you able to perform the specific duties of the position for which you are applying including but not limited to: lifting, bending, climbing ladders, and/or holding tools for an extended period of time, with or without reasonable accommodation (please refer to the job description for the specific position for which you are applying for details regarding essential functions)?

Yes

The Harver Company Employment History

Have you ever worked for The Harver Company before?

Details of previous work for Harver

References

Name of Reference 1

Please enter the name of a reference for your employment application.

Reference 1 Company

Reference 1 City

Reference 1 State

Reference 1 Email

Reference 1 Phone

Phone

Name of Reference 2

Reference 2 Company

Reference 2 City

Reference 2 State

Reference 2 Email

Reference 2 Phone

Phone

Name of Reference 3

Reference 3 Company

Reference 3 City

Reference 3 State

Reference 3 Email

Reference 3 Phone

Phone

Work History

Work History Previous Employer 1

Previous Employment 1 Supervisor

Previous Employment 1 Specialty

Date you started previous employment

mm/dd/yyyy

Date you ended previous employment

mm/dd/yyyy

Prev. Employment 1 Reason for Leaving

Work History Previous Employer 2

Previous Employment 2 Supervisor

Previous Employment 2 Specialty

Date you started previous employment 2?

mm/dd/yyyy

Date you ended previous employment 2

mm/dd/yyyy

Work History Previous Employer 3

Previous Employment 3 Supervisor

Previous Employment 3 Specialty

Date you started previous employment 3

mm/dd/yyyy

Date you ended previous employment 3

mm/dd/yyyy

Disclaimer and Signature

I certify that my answers on this applicaiton are true and complete to the best of my knowledge. If this application leads to employment, I understand that false or misleading information in my application or interview may result in my release. By typing/signing my name here representing my signature, I certify that my answers are true and complete to the best of my knowledge. I agree that typing my name here represents my signature and authorization to accept my application.

Date of Application and Certification

mm/dd/yyyy

Authorization for Release of Information and Waiver of Potential Claims

To Whom It May Concern:

I am applying for a job at The Harver Company (hereinafter, “the Company”) located at 10000 SW Commerce Circle and whose contact person is the Superintendent or Human Resources and phone number is (503) 624-1453.

I hereby authorize the Company to contact the references, past employers, schools, and training institutions listed in the Employment Application (and my resume) or any other person or entity that may have information about my (1) prior employment, or (2) educational experiences, or (3) statements contained in this Application.

I hereby authorize any references, past employers, schools, and training institutions listed in my Employment Application (and my resume) to release to the Company all information about my (1) prior employment, or (2) educational experiences, or (3) statements contained in the Employment Application (and my resume). I hereby waive any potential claim that I may have against any references, past employers, schools, and training institutions listed in my Employment Application (and my resume), and their employees, officers, and directors, for providing information about me to the Company.

I hereby agree to waive any claim that I may have against the Company and to defend and hold the Company harmless from any and all claims that may arise from the Company contacting any person or entity described in this release.

This authorization to release information is good for 120 days from the date written below. The waiver and indemnification provisions in this Authorization will survive the expiration of this Authorization.

A copy or facsimile of this Authorization may be treated and relied upon as if it were an original. By typing/signing my name here representing my signature, I acknowledge and authorize release of information and agree to the waiver of potential claims as stated above.

Date of Authorization and Release

mm/dd/yyyy

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