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Ron Perrin
Water Technologies EMPLOYMENT APPLICATION
PO Box 101614 Fort Worth, Texas 76185
Notice: We maintain a drug and alcohol free work place pre employment drug testing may be required. Consent to random drug testing is a condition of employment. Applicant understands that this job requires out of town travel in addition to working evening and weekends. DATE____________________
1. Name:_______________________________________________________________
Last First Middle
2. Address:______________________________________________________________
Number Street
_____________________________________________________________
City State Zip code
3. Telephone Number: ( )_____________ Cell Number: ( )________________
4. Date of Birth: _________/_________/__________ e-mail ______________________
Month Day Year
5. Social Security Number: ___________________________
6. Are you a U.S. citizen? _________ ___________
Yes No
7. Do you have a valid driver’s license? Drivers License Number and State: ___________________________ __________
8. Height (Ft & Inches):____________ Weight (pounds): _________________
9. EMERGENCY CONTACT INFORMATION:
Name__________________________________ Phone_______________________
Address________________________________ Cell Phone__________________
_________________________________ Relationship?_______________
A. Work History – Beginning with your present or most recent job, list all employment for the previous 3 years. Attach extra pages if necessary.
1. From: ________ to _________ Employer:________________________________
Address: _____________________________________________________________
Phone: ____________________ Job title: __________________________________
Duties: _______________________________________________________________
Supervisor: ______________________ name of Co-worker: ____________________
Reason for leaving: ______________________________________________________
2. From: ________ to _________ Employer:________________________________
Address: _____________________________________________________________
Phone: ____________________ Job title: __________________________________
Duties: _______________________________________________________________
Supervisor: ______________________ name of Co-worker: ____________________
Reason for leaving: ______________________________________________________
3. From: ________ to _________ Employer:________________________________
Address: _____________________________________________________________
Phone: ____________________ Job title: __________________________________
Duties: _______________________________________________________________
Supervisor: ______________________ name of Co-worker: ____________________
Reason for leaving: _____________________________________________________
B. Educational History –
1. High School - Graduated? Yes No Year______ GED?_____ Year______
2. College or University Attended: _____________________________________
Units completed: _______ Major / Minor: ______________________________
Degree received, if any, and date: ______________________________________
3. List other schools attended (trade, vocational, business, etc.)
List any specialized skills, license or machinery or equipment which you can operate.
_________________________________________________________________
_________________________________________________________________
D. ARRESTS, DETENTIONS AND LITIGATION At this time we contract with several federal prisons. Your background will be checked by these institutions before you are allowed to enter a federal prison. Employment is conditional upon being able to service federal prisons.
1. List any Felony or class A convictions ________________ Date________
___________________ Date________ ________________ Date________
2. Have you ever been arrested for a felony or DWI Yes ____ No ____
E. Traffic Record – This job requires a lot of drive time in a company truck.
1. Has your driver’s license ever been suspended or revoked?
Yes ____________ No ___________
If yes, give date, location and reasons. __________________________________
_________________________________________________________________
2. With what company do you carry auto insurance? _________________________
3. List to the best of your memory all traffic citations you have received, excluding parking tickets.
Month & Year Charge City & State Disposition
___________________________________________________________
___________________________________________________________
Have you had more than three traffic accidents in the past three years? ____________________________________________________________
F. Medical History: Climbing 150’ Ladders requires good health, and that you are physically fit.
1. List the following information concerning all doctors consulted within the last 3 years and all periods of hospitalization within the past 5 years.
Reason(s) Month & year # of days Physician and or Hospital
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
2. Do you have any physical handicaps, chronic diseases or disabilities?
Yes____________ No ____________
If yes, explain. ____________________________________________________________________________________________________________________________________
__________________________________________________________________
3. Have you ever received workman's compensation or any other disability insurance payments?
Yes _____________ No ___________
If yes, explain.
_________________________________________________________________
_________________________________________________________________
4. Are you currently taking any medication prescribed by your physician that would affect you working in high places or cause drowsiness?
Yes ____________ No ____________
If yes, explain.
_________________________________________________________________
_________________________________________________________________
C. REFERENCES - List 3 persons who know you well enough to provide current information about you. Do not list relatives or former employers.
Name: _________________________ Phone: _____________________________
E-Mail Address________________________ Years Known: _________________
Name: _________________________ Phone: _________________________
E-Mail Address________________________ Years Known: _________________
Name: _________________________ Phone: _________________________
E-Mail Address________________________ Years Known: _________________
Photo & Video acknowledgment;
All photos and video taken by employees, contractors or associates of RON PERRIN WATER TECHNOLOGIES are the property of Ron Perrin Water Technologies. Employees, contractors or associates are occasionally seen in photographs & video that is used to promote the company and or its services. There is no additional compensation should your image be in a photograph used to promote this company.
I hereby certify that there are no willful misrepresentations, omissions or falsifications in the forgoing statements and answers to questions. I am fully aware that any such willful misrepresentations, omissions or falsifications may be grounds for immediate rejection or termination of employment. My image in photos or video may be used to promote Ron Perrin Water Technologies.
_________________________________ ___________________
Signature of applicant Date
-------------------------------------------------------------
Office Use Only:
Interview notes:_________________________________________________________________________
Hire Date: __________________________ . Probationary End Date_____________________________.
Agreements & Acknowledgements.
AGREEMENT RELATING TO EMPLOYMENT AND POST-EMPLOYMENT COMPETITION*
This Agreement is between the undersigned individual ("Employee") and
Ron Perrin Water Technologies("RPWT").
RECITALS
--------
A. RPWT is a service company which provides a variety of services
to the water utility industry, private and public institutions.
B. RPWT has a proprietary interest in its business methods and systems
("Systems") which include, but are not limited to, policy and procedure
manuals, computer programs, inspection forms and information, supplier
information, supplier information, and procedures. Client data base & information on the needs of clients, all of which information is not publicly disclosed and is considered by RPWT to be confidential trade secrets; and
C. RPWT intends to employ Employee in a position where Employee will have
access to information relating to RPWT's Systems and RPWT will encourage
Employee to develop personal relationships with RPWT's clients and prospective
clients; and
D. RPWT will be vulnerable to unfair post-employment competition by Employees
since Employee will have access to RPWT Systems and will have a personal
relationship with RPWT's clients and prospective clients; and
E. In consideration of the severance and other employment benefits provided
for herein, Employee was willing to enter into this Agreement with RPWT as a
condition of employment, pursuant to which Employee will limit his right to
compete against RPWT following termination of employment for any reason to the
limited extent set forth in this Agreement.
NOW, THEREFORE, intending to be legally bound, the parties agree as follows:
Article 1. NON-DISCLOSURE AGREEMENT: RPWT may, pursuant to Employee's
employment hereunder provide and confide to Employee RPWT's Systems,
techniques and methods of operation developed at great expense by ARA and
which Employee recognizes to be unique assets of RPWT's business. Employee
shall not, during or after the term of employment, directly or indirectly,
in any manner utilize or disclose to any person, firm, corporation,
association or other entity, except where required by law: (a) any such
Systems, techniques and methods of operation; (b) any sales prospects,
customer lists, products, research or data of any kind; or (c) any information
relating to strategic plans, sales costs, profits or the financial condition
of RPWT or any of its customers or prospective customers, which is not
generally known to the public or recognized as standard practice in the
industries in which RPWT shall be engaged. Employee shall not divulge the condition of any water system nor shall an Employee post share or otherwise disclose photographs or video of the condition of a water system that RPWT has provided services for.
Article 2. NONCOMPETITION AGREEMENT:
A. Subject to the provisions of Paragraph B below, Employee, for a
period of two (2) years following termination of his employment, shall not,
without RPWT's written permission, directly or indirectly, on Employee's behalf
or on behalf of any other person, firm, corporation, association or other
entity, engage in, or in any way be concerned with or negotiate for, or
acquire or maintain any ownership interest in any business or activity which
is the same, similar to or competitive with that conducted by, engaged in or
developed for later implementation by RPWT at any time during the term of
Employee's employment.
B. The provisions set forth in Paragraph A, above, shall apply to all
fifty states RPWT may be engaged in business at the termination of Employee's employment or at any time within twelve months prior thereto; but only if Employee was directly or indirectly involved or exposed to plans for such business at any time within twelve (12) months prior to termination.
C. Employee further agrees that Employee shall not for a period of two
years, directly or indirectly, at any time in any manner, induce or attempt
to influence any employees of RPWT to terminate their employment with RPWT.
D. Employee acknowledges that in the event of any violation by Employee of
the provisions set forth in Article 1 above or this Article 2, RPWT will
sustain serious, irreparable and substantial harm to its business, the extent
of which will be difficult to determine and impossible to remedy by an action
at law for money damages. Employee agrees that, in the event of such violation or threatened violation by Employee, RPWT shall be entitled to an injunction before trial from any court of competent jurisdiction as a matter of course upon the posting of not more than a nominal bond, in addition to all such other legal and equitable remedies as may be available to RPWT. Employee further agrees that, in the event any of the provisions of this Agreement are determined by a court of competent jurisdiction to be contrary to any applicable statute, law or rule, or for any reason unenforceable as written, such court may modify any of such provisions so as to permit enforcement therefore as thus modified.
TERM OF EMPLOYEMENT: Employee acknowledges a 180 day probationary period
Giving RPWT has the right to terminate Employee's employment at any time for any reason. After the 180 day probationary period the employee may qualify for
Texas unemployment benefits if the termination is not for good cause. Employee acknowledges that RPWT has good cause to maintain a drug free workplace and agrees to pre-employment drug testing and or random drug testing to be conducted without notice and paid for by RPWT. RPWT contracts with the Federal Bureau of Prisons. Employees must pass a background check conducted by BOP.
MISCELLANEOUS:
You may NOT bring a wife, girlfriend or pet with you on trips or to jobsites.
Pursuant to Employee's employment illegal drugs are not allowed on job sites, property or in vehicles owned by RPWT. Other prohibited items include pornography, fireworks, firearms or other weapons. Money owed the company for training, damage of equipment, loss of equipment or insurance deductable may be
withheld from my pay.
Applicant _____________________________________ _____________________________
Witness
RPWT Representative _______________________________ ___________________________
Ronald L. Perrin Print Witness Name
Date ____________________
................
................
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