Customer Service Representative Application

CUSTOMER SERVICE REPRESENTATIVE APPLICATION

Step 1 of 11

Personal Information

Name(Required)

First Middle Last

Current Address(Required)

Street Address Address Line 2 City State ZIP Code

Permanent Address (If Different than Curent Address)

Street Address Address Line 2 City State ZIP Code

Phone Number(Required)

Alternate Phone Number

Driver's License Number

Date of Birth(Required)

Applicant Statement and Consent

I certify that all information I have provided in order to apply for and secure work with the employer is true, complete and correct.

I expressly authorize, without reservation, the employer, its representatives, employees or agents to contact and obtain information from all references (personal and professional), employers, public agencies, licensing authorities and educational institutions and to otherwise verify the accuracy of all information provided by me in this application, resume, or job interview. I hereby waive any and all rights and claims I may have regarding the employer, its agents, employees or representatives, for seeking, gathering and using truthful and non-defamatory information, in a lawful manner, in the employment process and all other persons, corporations or organizations for furnishing such information about me.

I understand that this employer does not unlawfully discriminate in employment and no question on this application is used for the purpose of limiting or elimination any applicant from consideration for employment on any basis prohibited by applicable local, state or federal law.

I understand that this application remains current for only 30 days. At the conclusion of that time, if I have not heard from the employer and still wish to be considered for employment, it will be necessary to reapply and fill out a new application.

If I am hired, I understand that I am free to resign at any time, with or without cause and without prior notice, and the employer reserves the same right to terminate my employment at any time, with or without cause and without prior notice, except as may be required by law. This application does not constitute an agreement or contract for employment for any specified period or definite duration. I understand that no supervisor or representative fo the employer is authorized to make any assurances to the contrary and that no implied oral or written agreements contrary to the foregoing express language are valid unless they are in writing and signed by the employer's president.

I also understand that if I am hired, I will be required to provide proof of identity and legal authority to work in the United States and that federal immigration laws require me to complete an 1-9 Form in this regard.

I understand that any information provided by me that is found to be false, incomplete or misrepresented in any respect, will be sufficient cause to (i) eliminate me from further consideration for employment, or (ii) may result in my immediate discharge from the employer's service, whenever it is discovered.

I agree to allow Abilene Aero - Lubbock Aero to perform any pertinent credit or OMV checks.

I understand that Abilene Aero - Lubbock Aero requires a pre-employment drug screen for the following: THC, PCP, cocaine, opiates, and amphetamines.

I also understand that if necessary, Abilene Aero - Lubbock Aero will do a ten year work history check.

I understand that as a condition of seeking employment with Abilene Aero - Lubbock Aero in a safety sensitive position, I must disclose all prior aviation employers (including air taxi/commuters, repair stations, etc.) to which I applied to perform or for which I performed safety sensitive functions since December 18, 1989 (the date on which FAA mandated drug testing began).

I have not tested positive or refused to test, on any pre-employment drug or alcohol test administered by an employer to which I have applied for, but did not obtain, safety sensitive transportation work cover by DOT agency drug and alcohol rules during the past two years.

Disclosure & Authorization for Consumer Reports

Please read the following statements carefully.

In connection with my application for 12mployment (including contract or volunteer services) with Abilene Aero-Lubbock Aero ("Company"), I understand consum12r reports will be requested by Quick Search ("Agency"). These reports may include names and dates of previous employers, reason for termination of employment, work experience, educational history, accidents, licensure, credit reports, etc., as applicable and allowed by law. I further understand that such reports may contain public record information such as, but not limited to: my driving record, workers' compensation claims, judgments, bankruptcy proceedings, criminal and civil records, etc., from government and other agencies that maintain such records.

In addition, investigative consumer reports (gathered from personal interviews, as applicable, with former employers, past or current associates of mine, etc.) to gather information regarding my work, character, general reputation, and personal characteristics, and professional or educational qualifications may be obtained.

If I am hired, I understand that my employer can use this disclosure and authorization to continue to obtain such consumer reports throughout my employment, contract period or volunteer service.

Authorization: I hereby authorize procurement of consumer and investigative report(s) by Company from Agency. If hired (or contracted), this authorization shall remain on file and shall serve as ongoing authorization for Company to procure such reports at any time during my employment, contract, or volunteer period. I authorize without reservation, any person, business or agency contacted by the consumer reporting agency to furnish the above-mentioned information.

This authorization is conditioned upon the following representations of my rights:

I understand that I have the right to make a request to the consumer reporting agency: Quick Search ("Agency"), 4155 Buena Vista, Dallas, TX 75204, telephone number (214) 358-2880 ext. 114, upon proper identification, to obtain copies of any reports furnished to Company by the Agency and to request the nature and substance of all information in its files on me at the time of my request, including the sources of information, and the Agency, on Company's behalf, will provide a complete and accurate disclosure of the nature and scope of the investigation covered by any investigative consumer report(s). The Agency will also disclose the recipients of any such reports on me which the Agency has previously furnished within the two year period for employment requests, and one year for other purposes preceding my request (California three years). I hereby consent to Company obtaining the above information from the Agency. I understand that I can dispute, at any time, any information that is inaccurate in any type of report with the Agency. I may view the Agency's privacy policy at their website: www.quicksius.com.

I understand that if the Company is located in California. Minnesota or Oklahoma, that I have the right to request a copy of any report the Company receives on me at the time the report is provided to Company.

As a California applicant, I understand that I have the right under Section 1786.22 of the California Civil Code to contact the Agency during reasonable hours (9:00 a.m. to 5:00 p.m. (CTZ) Monday through Friday) to obtain all information in Agency's file for my review. I may obtain such information as follows: 1) In person at the Agency's offices (by appointment only), which address is listed above. I can have someone accompany me to the Agency's offices. Agency may require this third party to present reasonable identification. I may be required at the time of such visit to sign an authorization for the Agency to disclose to or discuss Agency's information with this third party; 2) By certified mail, if I have previously provided identification in a written request that my file be sent to me or to a third party identified by me; 3) By telephone, if I have previously provided proper identification in writing to Agency; and 4) Agency has trained personnel to explain any information in my file to me and if the file contains any information that is coded, such will be explained to me.

I understand that if I am applying for employment in New York, that I have the right to receive a copy of Article 23-A of the New York Correction Law

I understand that if the report is provided to an employer in the State of Washington. that I can contact the following office for more information regarding my rights under Washington state law in regard to these reports: State of Washington Attorney General, Consumer Protection Division, 800 5th Ave, Ste. 2000, Seattle, Washington 98104-3188, (206) 464-7744.

To read the full Summary of Your Rights Under the Fair Credit Reporting Act, please follow this link: Full Summary of Your Rights.

Applicant Name

Self Identification
The federal government under Executive Order 11246 requires the corporation to report sex and race/ethnic origin of applicants for employment. Submission of information is voluntary. and failure to provide it will not subject you to any adverse treatment. Abilene Aero-Lubbock Aero is an equal opportunity corporation and does not discriminate on the basis of race, color, sex, national origin, religion, age, disability or veteran status in admission or access to, or treatment or employment in, its programs and activities.
Your Name
Position Applied For
Date of Application
Gender
Male
Female
Race/Ethnicity

Hispanic or Latino: A person of Cuban, Mexican, Puerto Rican, South or Central American, or other Spanish culture or origin regardless of race.

White (Not Hispanic or Latino): A person having origins in any of the original peoples of Europe, the Middle East or North Africa.

Black or African American (Not Hispanic or Latino): A person having origins in any of the black racial groups of Africa.

Native Hawaiian or Pacific Islander (Not Hispanic or Latino): A person having origins in any of the peoples of Hawaii, Guam, Samoa or other Pacific Islands.

Asian (Not Hispanic or Latino): A person having origins in any of the original peoples of the Far East, Southeast Asia or the Indian Subcontinent, including, for example, Cambodia, China, India, Japan, Korea, Malaysia, Pakistan, the Philippine Islands, Thailand and Vietnam.

Native American or Alaska Native (Not Hispanic or Latino): A person having origins in any of the original peoples of North and South America (including Central America) and who maintains tribal affiliation or community attachment.

Two or more races All persons who identify with more than one of the above races.

I do not wish to disclose

Voluntary Self-Identification of Veterans
This employer is a Government contractor subject to the Vietnam Era Veterans' Readjustment Assistance Act of 1974, as amended by the Jobs for Veterans Act of 2002, 38 U.S.C. 4212 (VEVRAA), which requires Government contractors to take affirmative action to employ and advance in employment: (1) disabled veterans; (2) recently separated veterans; (3)active duty wartime or campaign badge veterans; and (4) Armed Forces service medal veterans. These classifications are defined as follows:
A "disabled veteran" is one of the following:

A veteran of the U.S. military, ground, naval or air service who is entitled to compensation (or who but for the receipt of military retired pay would be entitled to compensation) under laws administered by the Secretary of Veterans Affairs; or

A person who was discharged or released from active duty because of a service-connected disability.

A "recently separated veteran" means any veteran during the three-year period beginning on the date of such veteran's discharge or release from active duty in the U.S. military, ground, naval, or air service.
An "active duty wartime or campaign badge veteran" means a veteran who served on active duty in the U.S. military, ground, naval or air service during a war, or in a campaign or expedition for which a campaign badge has been authorized under the laws administered by the Department of Defense.

An "Armed forces service medal veteran" means a veteran who, while serving on active duty in the U.S. military, ground, naval or air service, participated in a United States military operation for which an Armed Forces service medal was awarded pursuant to Executive Order 12985.

Protected veterans may have additional rights under USERRA-the Uniformed Services Employment and Reemployment Rights Act. In particular, if you were absent from employment in order to perform service in the uniformed service, you may be entitled to be reemployed by your employer in the position you would have obtained with reasonable certainty if not for the absence due to service. For more information, call the U.S. Department of Labor's Veterans Employment and Training Service (VETS), toll-free, at 1-866-4-USA-DOL.
Self-Identification:
As a Government contractor subject to VEVRAA, we are required to submit a report to the United States Department of Labor each year identifying the number of our employees belonging to each specified "protected veteran" category. If you believe you belong to any of the categories of protected veterans listed above, please indicate by checking the appropriate box below. If you are not a veteran, select box 1 OR select the box(s) that apply to your veteran status.
I'm not a veteran (I did not serve in the military)
Not a veteran
I belong to the following classifications of protected veterans (Check all that apply)
Disabled Veteran
Recently Separated Veteran
Active Wartime or Campaign Badge Veteran
Armed Forces Service Medal Veteran
If you are a recently separated veteran, please list your discharge date.
I'm not a PROTECTED veteran (I served in the military but do not fall into any veteran categories listed above)
Not a protected veteran
I choose not to identify my veteran status
Choose not to disclose
Reasonable Accomodation Notice: If you are a disabled veteran it would assist us if you tell us whether there are accommodations we could make that would enable you to perform the essential functions of the job, including special equipment, changes in the physical layout of the job, changes in the way the job is customarily performed, provision of personal assistance services or other accommodations. This information will assist us in making reasonable accommodations for your disability.
Submission of this information is voluntary and refusal to provide it will not subject you to any adverse treatment. The information provided will be used only in ways that are not inconsistent with the Vietnam Era Veterans' Readjustment Assistance Act of 1974, as amended.

The information you submit will be kept confidential, except that (i) supervisors and managers may be informed regarding restrictions on the work or duties of disabled veterans, and regarding necessary accommodations; (ii) first aid and safety personnel may be informed, when and to the extent appropriate, if you have a condition that might require emergency treatment; and (iii) Government officials engaged in enforcing laws administered by the Office of Federal Contract Compliance Programs, or enforcing the Americans with Disabilities Act, may be informed.

Voluntary Self-Identification of Disability
Why are you being asked to complete this form>
Because we do business with the government, we must reach out to, hire, and provide equal opportunity to qualified people with disabilities.* To help us measure how well we are doing, we are asking you to tell us if you have a disability or if you ever had a disability. Completing this form is voluntary, but we hope that you will choose to fill it out. If you are applying for a job, any answer you give will be kept private and will not be used against you in any way.

If you already work for us, your answer will not be used against you in any way. Because a person may become disabled at any time, we are required to ask all of our employees to update their information every five years. You may voluntarily self-identify as having a disability on this form without fear of any punishment because you did not identify as having a disability earlier.

How do I know if I have a disability

You are considered to have a disability if you have a physical or mental impairment or medical condition that substantially limits a major life activity, or if you have a history or record of such an impairment or medical condition. Disabilities include, but are not limited to:

Blindness

Deafness

Cancer

Diabetes

Eplipsey

Autism

Cerebral palsy

HIV/ADIS

Schizophrenia

Muscular dystrophy

Bipolar disorder

Major depression

Multiple sclerosis (MS)

Missing limbs or partially missing limbs

Post-traumatic stress disorder (PTSD)

Obsessive compulsive disorder

Impairments requiring the use of a wheelchair

Intellectual disability (previously called mental retardation)

Please select one of the options below

Yes, I have a disability (or previously had a disability)

No, I don't have a disability

I don't wish to answer
Reasonable Asscommodation Noitce
Federal law requires employers to provide reasonable accommodation to qualified individuals with disabilities. Please tell us if you require a reasonable accommodation to apply for a job or to perform your job. Examples of reasonable accommodation include making a change to the application process or work procedures, providing documents in an alternate format, using a sign language interpreter, or using specialized equipment.

*Section 503 of the Rehabilitation Act of 1973, as amended. For more information about this form or the equal employment of the Rehabilitation Act of 1973, as amended. For more information about this form or the equal employment obligations of Federal contractors, visit the U.S. Department of Labor's Office of Federal Contract Compliance Programs (OFCCP) website at www.dol.gov/ofccp.

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.

General Consents & Disclosures
Reasonble Accommodation Needs: If you need any reasonable accommodations to complete this Application Form 􀀃r other elements of the application process, please let us know. We will attempt to assist you 1n applying for a job with Abilene Aero/Lubbock Aero.
Employment-At-Will: I understand and agree that my employment will be at will and may be terminated by me or Abilene Aero/Lubbock Aero at any time for any cause or no cause. I understand and agree that all benefits, programs, rules and policies of Abilene Aero/Lubbock Aero are subject to exceptions or change at will at any time as decided by Abilene Aero/Lubbock Aero. Also, it is understood that completion of this application does not guarantee you a job with Abilene Aero/Lubbock Aero.

Confidentiality and Trade Secrets: I agree that except at the request and for the benefit of Abilene Aero/Lubbock Aero I will not disclose to anyone or use for my own purposes any of Abilene Aero/Lubbock Aero's confidential or proprietary information, either during or after my employment. I understand and agree that Abilene Aero/Lubbock Aero's trade secrets, bidding, costs, pricing, marketing information and techniques, designs, methods of engineering and production, financial and market information, computer software, sources of supply, customer names and information and employee names and information are confidential and proprietary information of Abilene Aero/Lubbock Aero. I also agree that I will not make written or other copies of notes regarding these matters except as necessary to perform my job, and I agree that if my employment with Abilene Aero/Lubbock Aero ends, I will deliver to Abilene Aero/Lubbock Aero all material of any kind that I have relating to Abilene Aero/Lubbock Aero including any such copies or notes. I also agree that I will disclose and assign to Abilene Aero/Lubbock Aero any invention, design or process which I conceive or develop while employed by Abilene Aero/Lubbock Aero relating to Abilene Aero/Lubbock Aero's business or to any product or service offered or being developed by Abilene Aero/Lubbock Aero and that all such designs or conceptions shall be the property of Abilene Aero/Lubbock Aero.

Searches and Inspections: I agree that Abilene Aero/Lubbock Aero may conduct reasonable inspections of any lockers, desks, hardware, software or other Abilene Aero/Lubbock Aero property I may be using, and of any of my own property I bring onto Abilene Aero/Lubbock Aero's premises (Including vehicles, packages and purses) at any time, and I waive and promise not to make any claims against Abilene Aero/Lubbock Aero (or its employees, directors, owners or agents) relating to such inspection.

Truth/ Accuracy/Completeness: I certify that the facts contained in this application are true and complete. I understand that any false statement(s) in this application shall be the basis for my rejection or dismissal from employment. Resumes will not be accepted in lieu of a completed Application Form. This application must be completed in its entirety. That means that there will be NO BLANK SPACES. If a question or section does not apply to you or the job you are applying for, write in the area/section "not applicable" or "N/A" so that we will understand your answer. If you leave any spaces/sections blank the application will be incomplete and invalid. We do not accept incomplete applications.

Authorization and Waiver: The State of Texas allows an Employer to obtain information about a person's "job performance." "Job performance" means the manner in which an employee performs a position of employment and includes an analysis of the employee's attendance at work, attitudes, effort, knowledge, behaviors, and skills.

I authorize and request my former employers, references, educational institutions, and any credit agencies or reporting services which have information about me, to give Abilene Aero/Lubbock Aero and subsidiaries any and all information and opinions about me in their possession and which may lawfully be disclosed. I hereby waive written notice of such release of information and opinions, and I release such former employers, references, educational institutions, and credit agencies or reporting services from any liability or claim relating to such release of information and opinions. I also authorize and request federal, state, and local governmental agencies to release to Abilene Aero/Lubbock Aero any information requested concerning any criminal convictions on my record. A photocopy of this signed authorization and waiver shall be valid as an original.

If given a bona fide qualified-conditional job offer, I also authorize Abilene Aero/Lubbock Aero to seek, if they desire, medical and health background information on me that could be pertinent to the job(s) I am interested in.

I understand that an offer of employment and continued employment with Abilene Aero/Lubbock Aero is contingent upon my furnishing satisfactory proof of my authorization to work in the United States.

Also, I understand Abilene Aero/Lubbock Aero may adopt an Arbitration Agreement to resolve any disputes concerning complaints I have about my employment or terms of my employment.
Drug Testing and Physical Examinations: I hereby give my consent to Abilene Aero/Lubbock Aero, and its agents or independent contractors/vendors, to perform appropriate tests or examinations on me for alcohol, illegal drugs, and/or other pre-employment tests, including a pre-employment physical examination, with the results of these tests or examinations to be released to Abilene Aero/Lubbock Aero for whatever use it deems fair and appropriate under the circumstances.

Monitoring Activity: I understand Abilene Aero/Lubbock Aero may monitor certain employee activity, particularly communications and the use of communication devices. Use of such communication devices as these may be monitored: telephones, fax machines, computers, iPads, e-mails, web pages, cell phones and pagers. Also, video tapings may be made where Abilene Aero/Lubbock Aero deems necessary.

Equal Employment Opportunity Employer: We believe firmly in providing equal employment opportunities to those who apply for a job with us. We will not discriminate in recruitment, processing applications, interviews, hiring, and promotions. We will not discriminate on the basis of: race, color, religion, sex, gender, age, national origin, ancestry, marital status, veteran status, parenthood, or physical and mental disability disclosed to us (with or without reasonable accommodation).

Agreement: I understand the terms and statements above and agree to them. Also, I am aware that completion of the Application Form does not in itself mean I will be interviewed for a position or be given a job offer. By signing below I acknowledge my acceptance of these statements and conditions of employment at Abilene Aero/Lubbock Aero.
Acknowledgement(Required)
I agree
By checking this box and putting your name below, you agree to all above statements.
Your Name(Required)
Phone
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