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Application for Employment Package

– Applicant’s (Arbitration) Agreement
– Application for Employment
– Disclaimer of Nepotism
– Reference Release Form
– Disclosure and Release Form
– Affidavit of OH Residency and Felony Charges-Convictions
– Equal Employment Opportunity Voluntary Self-Identification

Incomplete Applications will not be accepted.

When applying for an open posted position, the application package must be completed in full and returned by the deadline date listed on the posting.

Applicant's Agreement

I certify that all answers given herein are true, accurate and complete to the best of my knowledge. I understand that the falsification, misrepresentation or omission of fact on this application, in interview(s) or on any other accompanying or required documents will be cause for denial of employment or immediate termination of employment, regardless of when or how discovered.

I authorize investigation of all statements and information contained in this application for employment as may be necessary in arriving at an employment decision. I release from all liability anyone supplying such information and I release TAC Industries from all liability that might result from making an investigation.

TAC INDUSTRIES believes that hiring qualified individuals to fill positions contributes to the overall strategic success of TAC INDUSTRIES. Each Associate/Apprentice, while employed, is hired to make significant contributions to TAC INDUSTRIES. In hiring the most qualified candidates for positions, a preemployment screening process is applicable. The Support Services Department will contact the chosen candidate and an offer will be made contingent upon completion of the below pre-employment screenings. I understand that, as a condition of initial or continued employment, I agree to submit to such lawful examinations required by TAC INDUSTRIES.
– Reference checks. The hiring manager or the Support Services Department may check references for chosen candidates.
– Criminal background checks. Satisfactory results of Local and State Records Checks
– Negative Results of Abuse Registry and/or Nursing Abuse Registry
– Negative Results of a Two-Step Monteux TB Test
– Negative Results of a Drug and Alcohol Screen

Once the Support Services Department receives satisfactory results from the above pre-employment screening process, the Support Services Department will notify the candidate to confirm the initial employment offer and start date.

I also understand that I am required to abide by all policies and procedures of TAC INDUSTRIES and that this is an application and is not intended to be a contract of employment.

I acknowledge that I have read and understand the above statements and hereby grant permission to confirm the information supplied on this application.

Date(Required)

Application for Employment

Applicants are considered for open positions without regard to race, color, religion, gender, national origin, age, disability, genetic information, veteran status, sexual orientation, marital status or the presence of a non-job related medical condition or handicap or other legally protected status.

Your Personal Information

Your Name(Required)

First Middle Last

Your Email Address

Enter Email Confirm Email

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Your Phone(Required)

Best Time To Call You

When is the best time for us to reach you via telephone?

Voluntary Self-Identification of Disability

Why are you being asked to complete this form?

We are a federal contractor or subcontractor. The law requires us to provide equal employment opportunity to qualified people with disabilities. We have a goal of having at least 7% of our workers as people with disabilities. The law says we must measure our progress towards this goal. To do this, we must ask applicants and employees if they have a disability or have ever had one. People can become disabled, so we need to ask this question at least every five years.

Completing this form is voluntary, and we hope that you will choose to do so. Your answer is confidential. No one who makes hiring decisions will see it. Your decision to complete the form and your answer will not harm you in any way. If you want to learn more about the law or this form, 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 have a disability?

A disability is a condition that substantially limits one or more of your “major life activities.” If you have or have ever had such a condition, you are a person with a disability. Disabilities include, but are not limited to:

• Alcohol or other substance use disorder (not currently using drugs illegally)
• Autoimmune disorder, for example, lupus, fibromyalgia, rheumatoid arthritis, HIV/AIDS
• Blind or low vision
• Cancer (past or present)
• Cardiovascular or heart disease
• Celiac disease
• Cerebral palsy
• Deaf or serious difficulty hearing
• Diabetes
• Disfigurement, for example, disfigurement caused by burns, wounds, accidents, or congenital disorders
• Epilepsy or other seizure disorder
• Gastrointestinal disorders, for example, Crohn’s Disease, irritable bowel syndrome
• Intellectual or developmental disability
• Mental health conditions, for example, depression, bipolar disorder, anxiety disorder, schizophrenia, PTSD
• Missing limbs or partially missing limbs
• Mobility impairment, benefiting from the use of a wheelchair, scooter, walker, leg brace(s) and/or other supports
• Nervous system condition, for example, migraine headaches, Parkinson’s disease, multiple sclerosis (MS)
• Neurodivergence, for example, attention-deficit/hyperactivity disorder (ADHD), autism spectrum disorder, dyslexia, dyspraxia, other learning disabilities
• Partial or complete paralysis (any cause)
• Pulmonary or respiratory conditions, for example, tuberculosis, asthma, emphysema
• Short stature (dwarfism)
• Traumatic brain injury

Please check one of the boxes below

Untitled

Yes, I have a disability, or have had one in the past

No, I do not have a disability and have not had one in the past

I do not want to answer

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.

Reference Release Form

Applicant's Name

First Last

Position Applied For

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone

I have applied for a position with TAC Industries. Before I may be considered a “qualified applicant” I must be able to provide a reference release form. Please feel free to provide the information requested to TAC Industries. I have voluntarily consented to full disclosure. I have read and understand that the questions asked below are relevant to the hiring decision. Your cooperation will be fundamental in my prospective employment with TAC Industries. Thank you for your consideration and assistance.

I hereby authorize the release of the below information to TAC Industries without any legal liability for the party that furnished the information.

Education

High School/GED

Name & Address

Years Completed

Graduated (yes or no)

College

Name & Address

Years Completed

Graduated (yes or no)

Degree/Certificate

Major

Post-Graduate

Name & Address

Years Completed

Graduated (yes or no)

Degree/Certificate

Major

Business or Trade

Name & Address

Years Completed

Graduated (yes or no)

Degree/Certificate

Major

Other

Name & Address

Years Completed

Graduated (yes or no)

Degree/Certificate

Major

A copy of university transcripts will be required for all applications for degreed positions. THE FINAL CANDIDATE MUST SUBMIT ORIGINAL UNIVERSITY TRANSCRIPTS FOR ALL DEGREED POSITIONS AND HIGH SCHOOL DIPLOMA/GED CERTIFICATE FOR ALL DIRECT SERVICE RELATED STAFF.

Additional Experience or Qualifications

References

Please list (3) references, excluding former employers and relatives, which TAC INDUSTRIES has permission to contact. MUST include phone numbers.

Name/Occupation

Street

City/State/Zip

Phone Number

Name/Occupation

Street

City/State/Zip

Phone Number

Name/Occupation

Street

City/State/Zip

Phone Number

Upload Your Resume(Required)

Upload your resume in .pdf, .doc or .docx format

Accepted file types: pdf, doc, docx, Max. file size: 25 MB.

Employment Experience

Present Employer

Address

Hourly Rate/Salary

Job Title

Supervisor

Reason for Leaving

Date Employed – Starting

Date Employed – Ending

Employment Experience

Previous Employer

Address

Hourly Rate/Salary

Job Title

Supervisor

Reason for Leaving

Date Employed – Starting

Date Employed – Ending

Employment Experience

Previous Employer

Address

Hourly Rate/Salary

Job Title

Supervisor

Reason for Leaving

Date Employed – Starting

Date Employed – Ending

DISCLAIMER OF NEPOTISM/CONFLICT OF INTEREST

TAC INDUSTRIES supports the belief that employment or conditions of employment must be fair and consistently applies to all persons. It is our belief that no employee or applicant for employment should receive or be perceived preferential treatment by any person holding a supervisory or management position. To ensure our employment practices are administered equitably and in accordance to law, Procedure TEP-011 (Anti-Nepotism/relationships in the Workplace) shall be followed.

This form must be completed when any one of the following incidents occur. Please check any which apply:

Applying for employment with TAC Industries

Applying for promotion or transfer within TAC Industries

Change in scheduled work house and/or work shift

Affected by the parameters established within Procedure TEP-011

Definitions

Family member: spouse, parent, child (whether dependent or not), sibling, in-laws of the same, grandparent, grandchild, and/or members of household. This policy also applies to romantic relationships.

IN ACCORDANCE TO THE ABOVE DEFINITIONS PLEASE ANSWER THE FOLLOWING QUESTIONS:

A Board Member currently serving on the TAC Industries Board is a family member.

A Management Associate (see applicable positions below) of TAC Industries is a family member

A Supervisory Associate of TAC Industries is a family member.

An Associate/Apprentice of TAC Industries is a family member.

An individual receiving services from TAC Industries is a family member.

I currently cohabitate with an Associate/Apprentice of TAC Industries.

explanation

If yes was checked for any of the above questions, please provide the family member’s name, position, current facility, how they are related to you and any other comments.

OHIO RESIDENCY AND ATTESTATION TO NOTIFY EMPLOYER

Check either 1 or 2 but not both.

1. The applicant states that he/she has been a resident of Ohio for the five-year period preceding this application. The applicate agrees to provide proof to TAC that He/She has been a resident of Ohio for the five-year period preceding this application.

2. The applicant states that he/she has not been a resident of Ohio for the five-year period preceding this application.

I hereby attest that I have not: 1) been convicted of, 2) pleaded guilty to, or 3) been found eligible for intervention in lieu of conviction, for any of the disqualifying offenses listed below and agree that I will notify my employer, TAC Industries, within 14 calendar days, if while employed, I am formally charged with, am convicted of, plead guilty to, or am found eligible for intervention in lieu of conviction for any of the disqualifying offenses. I understand that failure to make this notification may result in termination of employment.

Applicant's Name(Required)

Typing your name below constitutes your signature and agreement with the above statement.

First Last

Tier 1 Disqualifying Offenses (Permanent Exclusion)

2903.01 (aggravated murder)
2903.02 (murder)
2903.03 (voluntary manslaughter)
2903.11 (felonious assault)
2903.15 (permitting child abuse)
2903.16 (failing to provide for a functionally impaired person)
2903.34 (patient abuse and neglect)
2903.341 (patient endangerment)
2905.01 (kidnapping)
2905.02 (abduction)
2905.32 (human trafficking)
2905.33 (unlawful conduct with respect to documents)
2907.02 (rape)
2907.03 (sexual battery)
2907.04 (unlawful sexual conduct with a minor, formerly corruption of a minor)
2907.05 (gross sexual imposition)
2907.06 (sexual imposition)
2907.07 (importuning)
2907.08 (voyeurism)
2907.12 (felonious sexual penetration)
2907.31 (disseminating matter harmful to juveniles)
2907.32 (pandering obscenity)
2907.321 (pandering obscenity involving a minor)
2907.322 (pandering sexually oriented matter involving a minor)
2907.323 (illegal use of minor in nudity-oriented material or performance)
2909.22 (soliciting/providing support for act of terrorism)
2909.23 (making terrorist threat)
2909.24 (terrorism)
2913.40 (Medicaid fraud)
2923.01 (conspiracy) when the underlying offense is any of the offenses or violations on this list
2923.02 (attempt) when the underlying offense is any of the offenses or violations on this list
2923.03 (complicity) when the underlying offense is any of the offenses or violations on this list
A conviction related to fraud, theft, embezzlement, breach of fiduciary responsibility, or other financial misconduct involving a federal or state-funded program, excluding the disqualifying offenses set forth in section 2913.46 of the Revised Code (illegal use of supplemental nutrition assistance program [SNAP] or women, infants, and children [WIC] program benefits). A violation of an existing or former municipal ordinance or law of this state, any other state, or the United States that is substantially equivalent to any of the offenses or violations on this list.

Tier 2 Disqualifying Offenses (Ten-Year Exclusion)

2903.04 (involuntary manslaughter)
2903.041 (reckless homicide)
2905.04 (child stealing) as it existed prior to July 1, 1996
2905.05 (criminal child enticement)
2905.11 (extortion)
2907.21 (compelling prostitution)
2907.22 (promoting prostitution)
2907.23 (enticement or solicitation to patronize a prostitute, procurement of a prostitute for another)
2909.02 (aggravated arson)
2909.03 (arson)
2911.01 (aggravated robbery)
2911.11 (aggravated burglary)
2913.46 (illegal use of supplemental nutrition assistance program [SNAP] or women, infants, and children [WIC] program benefits)
2913.48 (workers’ compensation fraud)
2913.49 (identity fraud)
2917.02 (aggravated riot)
2923.01 (conspiracy) when the underlying offense is any of the offenses or violations on this list
2923.02 (attempt) when the underlying offense is any of the offenses or violations on this list
2923.03 (complicity) when the underlying offense is any of the offenses or violations on this list
2923.12 (carrying concealed weapon)
2923.122 (illegal conveyance or possession of deadly weapon or dangerous ordnance in a school safety zone, illegal possession of an object indistinguishable from a firearm in a school safety zone)
2923.123 (illegal conveyance, possession, or control of deadly weapon or dangerous ordnance into courthouse)
2923.13 (having weapons while under disability)
2923.161 (improperly discharging a firearm at or into a habitation or school)
2923.162 (discharge of firearm on or near prohibited premises)
2923.21 (improperly furnishing firearms to minor)
2923.32 (engaging in pattern of corrupt activity)
2923.42 (participating in criminal gang)
2925.02 (corrupting another with drugs)
2925.03 (trafficking in drugs)
2925.04 (illegal manufacture of drugs or cultivation of marijuana)
2925.041 (illegal assembly or possession of chemicals for the manufacture of drugs)
3716.11 (placing harmful objects in food or confection)
A violation of an existing or former municipal ordinance or law of this state, any other state, or the United States that is equivalent to any of the offenses or violations on this list.

Tier 3 Disqualifying Offenses (Seven-Year Exclusion)

959.13 (cruelty to animals)
959.131 (prohibitions concerning companion animals)
2903.12 (aggravated assault)
2903.21 (aggravated menacing)
2903.211 (menacing by stalking)
2905.12 (coercion)
2909.04 (disrupting public services)
2911.02 (robbery)
2911.12 (burglary)
2913.47 (insurance fraud)
2917.01 (inciting to violence)
2917.03 (riot)
2917.31 (inducing panic)
2919.22 (endangering children)
2919.25 (domestic violence)
2921.03 (intimidation)
2921.11 (perjury)
2921.13 (falsification, falsification in theft offense, falsification to purchase firearm, or falsification to obtain a concealed handgun license)
2921.34 (escape)
2921.35 (aiding escape or resistance to lawful authority)
2921.36 (illegal conveyance of weapons, drugs, or other prohibited items onto grounds of detention facility or institution)
2923.01 (conspiracy) when the underlying offense is any of the offenses or violations on this list
2923.02 (attempt) when the underlying offense is any of the offenses or violations on this list
2923.03 (complicity) when the underlying offense is any of the offenses or violations on this list
2925.05 (funding of drug or marijuana trafficking)
2925.06 (illegal administration or distribution of anabolic steroids)
2925.24 (tampering with drugs)
2927.12 (ethnic intimidation)
A violation of an existing or former municipal ordinance or law of this state, any other state, or the United States that is substantially equivalent to any of the offenses or violations on this list.

Tier 4 Disqualifying Offenses (Five-Year Exclusion)

2903.13 (assault)
2903.22 (menacing)
2907.09 (public indecency)
2907.24 (soliciting after positive human immunodeficiency virus test)
2907.25 (prostitution)
2907.33 (deception to obtain matter harmful to juveniles)
2911.13 (breaking and entering)
2913.02 (theft)
2913.03 (unauthorized use of a vehicle)
2913.04 (unauthorized use of property, computer, cable, or telecommunication property)
2913.05 (telecommunications fraud)
2913.11 (passing bad checks)
2913.21 (misuse of credit cards)
2913.31 (forgery, forging identification cards)
2913.32 (criminal simulation)
2913.41 (defrauding a rental agency or hostelry)
2913.42 (tampering with records)
2913.43 (securing writings by deception)
2913.44 (personating an officer)
2913.441 (unlawful display of law enforcement emblem)
2913.45 (defrauding creditors)
2913.51 (receiving stolen property)
2919.12 (unlawful abortion)
2919.121 (unlawful abortion upon minor)
2919.123 (unlawful distribution of an abortion-inducing drug)
2919.23 (interference with custody)
2919.24 (contributing to unruliness or delinquency of child)
2921.12 (tampering with evidence)
2921.21 (compounding a crime)
2921.24 (disclosure of confidential information)
2921.32 (obstructing justice)
2921.321 (assaulting/harassing police dog or horse/service animal)
2921.51 (impersonation of peace officer)
2923.01 (conspiracy) when the underlying offense is any of the offenses or violations on this list
2923.02 (attempt) when the underlying offense is any of the offenses or violations on this list
2923.03 (complicity) when the underlying offense is any of the offenses or violations on this list
2925.09 (illegal administration, dispensing, distribution, manufacture, possession, selling, or using any dangerous veterinary drug)
2925.11 (drug possession other than a minor drug possession offense)
2925.13 (permitting drug abuse)
2925.22 (deception to obtain dangerous drugs)
2925.23 (illegal processing of drug documents)
2925.36 (illegal dispensing of drug samples)
2925.55 (unlawful purchase of pseudoephedrine product)
2925.56 (unlawful sale of pseudoephedrine product)
A violation of an existing or former municipal ordinance or law of this state, any other state, or the United States that is substantially equivalent to any of the offenses or violations on this list.

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Application for Employment

Applicant's Agreement

Your Personal Information

Reference Release Form

Education

DISCLAIMER OF NEPOTISM/CONFLICT OF INTEREST

Definitions

OHIO RESIDENCY AND ATTESTATION TO NOTIFY EMPLOYER

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