EMPLOYMENT APPLICATION WATER PIK, INC. a subsidiary of CHURCH & DWIGHT CO., INC. An Equal Opportunity Employer

Transcription

1 EMPLOYMENT APPLICATION WATER PIK, INC. a subsidiary of CHURCH & DWIGHT CO., INC. An Equal Opportunity Employer *Required fields are highlighted in yellow. THIS APPLICATION DOES NOT CREATE A CONTRACT OF EMPLOYMENT. CONTACT INFORMATION First Name Last Name Middle Initial Suffix -Daytime -Mobile Current Address Home Address Street 1 Home Address Home Address Home Address Home Address From Date Previous Address - Required if Applicable Home Address Street 1 Home Address Home Address Home Address Home Address From Date To Date REQUIRED IDENTIFICATION INFORMATION Other/Maiden name - Required if Applicable If yes, please provide the Previous First Name If yes, please provide the Previous Middle Name If yes, please provide the Previous Last Name CRIMINAL HISTORY INQUIRY **A Note About Various Laws**

2 /city law applies to you as an applicant if: (a) you are applying to a Church & Dwight location within that state/city OR (b) you are currently residing within that state/city CRIMINAL BACKGROUND INFORMATION If you are currently residing in or applying for jobs in CA; CT; D.C.; HI; IL; MA; OR; RI; WA; Buffalo, NY; Columbia, MO; or Kansas, MO; or you are applying for a job in MN; NJ; VT; Austin, TX; Baltimore, MD; of Los Angeles, CA; Montgomery County, MD; Portland, OR; Prince George s County, MD; Rochester, NY; San Francisco, CA; or Seattle, WA, the below question should not be answered with a yes or no but instead with I currently reside in or am applying for job positions in CA; CT; D.C.; HI; IL; MA; OR; RI; WA; Buffalo, NY; Columbia, MO; or Kansas, MO; or I am applying for a job in MN; NJ; VT; Austin, TX; Baltimore, MD; ; of Los Angeles, CA; Montgomery County, MD; Portland, OR; Prince George s County, MD; Rochester, NY; San Francisco, CA; or Seattle, WA, and therefore am not required to answer the question on this application and for that reason am checking this box. Applicants are not required to disclose the existence of any conviction which has been annulled, erased, sealed, expunged, or otherwise eradicated by state or court order. CA applicants: Applicants are not required to disclose misdemeanor convictions involving marijuana or controlled substances as described in CA Labor Code that are more than two years old, and misdemeanor convictions for which probation has been successfully completed or discharged and that have been judicially dismissed. Applicants are not required to disclose any juvenile criminal history. CA (San Francisco): Applicants are not required to disclose felonies or misdemeanor convictions that are older than 7 years from the date of sentencing. Employers are prohibited from inquiring about convictions that arose out of conduct that has been decriminalized since the date of sentencing, including convictions related to the use or growing of marijuana. CT applicants: Applicants are not required to disclose any conviction that has been erased pursuant to 46(b)-146, 54-76(o) or (a) of the CT General Statute. Criminal records subject to erasure are records pertaining to a finding of delinquency or that a child was a member of a family with service needs, an adjudication as a youthful offender, a criminal charge for which the person has been found not guilty, or a conviction for which the person received an absolute pardon. Any person whose criminal records have been erased shall be deemed to have never been arrested within the meaning of the general statutes with respect to the proceedings so erased and may so swear under oath. GA applicants: Applicants may exclude convictions discharged under Georgia s First Offender Programs. MA applicants: Under Massachusetts law, an employer is prohibited from making written, pre-employment inquiries of an applicant about his or her criminal history. Massachusetts applicants should not respond to any question seeking criminal record information. After the application stage, applicants may omit from disclosing a first conviction for drunkenness, simple assault, speeding, affray, minor traffic violations, or disturbances of the peace. Applicants are also only required to disclose misdemeanor convictions occurring within three (3) years preceding the date of this application, unless the applicant has been convicted of any offense within the past three (3) years. Employers may not ask for information about a criminal record that has been sealed or expunged. NV applicants: Applicants are not required to disclose misdemeanor convictions older than 10 years. NY applicants: Applicants for job positions may exclude an adjudication as a youthful offender. OH applicants: Applicants with a conviction for a minor misdemeanor violation involving marijuana does not constitute a criminal record and does not need to be reported by the person so convicted in responding to the questions on this application. WA applicants: Applicants are not required to disclose felony or misdemeanor convictions older than 10 years.

3 A criminal conviction is not an automatic or absolute bar to employment, and while convictions will be considered based on the time and nature of the offense and as related to jobs applied for, applicants should answer the following question. An applicant that resides in or is applying for positions in the states/counties/cities that prohibit employers from asking the criminal question on the application will not be adversely impacted by checking the third box below in response to the criminal background question. Have you ever been convicted of or pled guilty or no contest to a felony or misdemeanor that has not been expunged, sealed, pardoned, annulled, statutorily erased or dismissed upon condition or probation? YES NO I currently reside in or am applying for a job in CA; CT; D.C.; HI; IL; MA; OR; RI; WA; Buffalo, NY; Columbia, MO; or Kansas, MO; or I am applying for a job in MN; NJ; Austin, TX; Baltimore, MD; of Los Angeles, CA Montgomery County, MD; Prince George s County, MD; Rochester, NY, San Francisco, CA, or Seattle, WA, and therefore am not required to answer the question on this application and for that reason am checking this box. If YES, please describe the circumstances of your conviction, including the date, nature, place of the offense, and disposition of the case. EDUCATION Highest Education School Type Did you graduate? School/University Name Date Degree Awarded Address Diploma or Degree Obtained Major Previous Education (Optional Section - Complete required fields if used) School Type

4 Did you graduate? School/University Name Date Degree Awarded Address Diploma or Degree Obtained Major Previous Education (Optional Section - Complete required fields if used) School Type Did you graduate? School/University Name Date Degree Awarded Address Diploma or Degree Obtained Major Achievements and Certifications List additional education, vocational, certifications, professional, military, or other information that you feel may be helpful to us in considering your application. EMPLOYMENT HISTORY Please complete all applicable fields in this section. You may include any verified work performed as a volunteer. Current or Last Employer Company Name Address1

5 Address2 Start Date End Date Supervisor Name Supervisor s Title Supervisor Phone Start Position/Title May we contact for verification of employment? End Position/Title Reason for Leaving Previous Employer Company Name Address1 Address2 Start Date End Date Supervisor Name Supervisor s Title Supervisor Phone Start Position/Title May we contact for verification of employment? End Position/Title Reason for Leaving Previous Employer Company Name Address1

6 Address2 Start Date End Date Supervisor Name Supervisor s Title Supervisor Phone Start Position/Title May we contact for verification of employment? End Position/Title Reason for Leaving REFERENCES 1. Name Company Business Relationship Relationship Length Address 2. Name Company Business Relationship Relationship Length Address 3. Name Company Business Relationship Relationship Length Address CERTIFICATION

7 The answers given by me to the foregoing questions and statements made by me are complete and true to the best of my knowledge and belief. I understand that any false information, omissions or misrepresentations of facts called for in this application, whether on this document or not, may result in rejection of my application or immediate discharge at any time during my employment. I authorize the Company to verify any of this information. I authorize all individuals, schools, and employers named and all financial institutions, law enforcement agencies, and all persons, except as specifically limited on this application, to provide information requested about me and I promise that I will not bring any legal claims or actions against my current or former employers due to their responses to any job reference request. I also understand that the use of illegal drugs is prohibited during employment. If Company policy requires, I am willing to submit to drug testing to detect the use of illegal drugs prior to and during employment. Refusal to comply with the drug screening process will make it impossible to complete this pre-placement requirement, which is a precondition for employment. Such refusal will be treated as sufficient grounds for rejection of the application for employment. I further understand that this employment application and any other Company documents are NOT contracts of employment. I understand that if hired, unless I am employed under a specific written contract or collective bargaining agreement, my employment will be at-will. I further understand that any person hired as an employee at will is free to leave employment upon proper notice and may be terminated by the Company at any time and for any reason (unless as otherwise provided pursuant to a collective bargaining agreement). I acknowledge that any oral or written statements to the contrary are hereby expressly disavowed and should not be relied upon by any prospective employee. I further understand that the completion of an application with Church & Dwight is a preliminary step to employment. It does not obligate Church & Dwight to offer employment to me, or for me to accept employment. I further acknowledge that if offered employment, any offer of employment may be a conditional offer of employment pending successful completion of a drug screening and/or criminal background check." FOR CALIFORNIA APPLICANTS: I RECOGNIZE THAT I MAY WAIVE MY RIGHT TO RECEIVE A COPY OF ANY PUBLIC RECORD OBTAINED BY THE COMPANY WHEN CONDUCTING A BACKGROUND INVESTIGATION OF ME PER THE REQUIREMENTS OF CALIFORNIA S INVESTIGATIVE CONSUMER REPORTING AGENCIES ACT (CALIFORNIA CIVIL CODE 1786, ET SEQ.). I MAY WAIVE MY RIGHT BY CHECKING THIS BOX: I DO NOT WISH TO RECEIVE A COPY OF ANY PUBLIC RECORDS OBTAINED BY THE COMPANY ABOUT ME THROUGH NON-ICRA SOURCES. FOR MARYLAND APPLICANTS: UNDER MARYLAND LAW, AN EMPLOYER MAY NOT REQUIRE OR DEMAND, AS A CONDITION OF EMPLOYMENT, PROSPECTIVE EMPLOYMENT OR CONTINUED EMPLOYMENT, THAT AN INDIVIDUAL SUBMIT TO OR TAKE A LIE DETECTOR OR SIMILAR TEST. EMPLOYER WHO VIOLATES THIS LAW IS GUILTY OF A MISDEMEANOR AND SUBJECT TO A FINE NOT EXCEEDING $100. FOR MASSACHUSETTS APPLICANTS: IT IS UNLAWFUL IN MASSACHUSETTS TO REQUIRE OR ADMINISTER A LIE DETECTOR TEST AS A CONDITION OF EMPLOYMENT OR CONTINUED EMPLOYMENT. AN EMPLOYER WHO VIOLATES THIS LAW SHALL BE SUBJECT TO CRIMINAL PENALTIES AND CIVIL LIABILITY. CHURCH & DWIGHT CO., INC. DOES NOT USE LIE DETECTOR TESTS AS PART OF THE APPLICATION PROCESS. FOR MONTANA APPLICANTS: THE EMPLOYMENT RELATIONSHIP IS GOVERNED BY THE WRONGFUL DISCHARGE FROM EMPLOYMENT ACT. MONT. CODE ANN FOR RHODE ISLAND APPLICANTS: IF YOU PROVIDE FALSE INFORMATION ABOUT YOUR ABILITY TO PERFORM THE ESSENTIAL FUNCTIONS OF THE JOB, WITH OR WITHOUT ACCOMMODATIONS, YOU MAY BE BARRED FROM FILING A CLAIM UNDER THE PROVISIONS OF THE WORKERS COMPENSATION ACT OF THE STATE OF RHODE This application will remain valid for 90 days. After that time, if you are still interested in employment at Church & Dwight you will need to complete another application. Signature