COVID-19 STATUS: Emergency Ice is OPEN, 100% operational and making scheduled deliveries. Details here. Employment Application PERSONAL INFORMATION Name* First Middle Last Social Security Number* Present Address* Street Address Address Line 2 City Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Armed Forces Americas Armed Forces Europe Armed Forces Pacific State ZIP Code Permanent Address* Street Address Address Line 2 City Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Armed Forces Americas Armed Forces Europe Armed Forces Pacific State ZIP Code Email Address* Day Phone* Night Phone* If you are under 18 can you furnish a work permit?* Yes No Drivers License Number* State* Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Armed Forces Americas Armed Forces Europe Armed Forces Pacific State Class* EMPLOYMENT DESIRED Position Applied For* Salary Desired* Type* Full Time Part Time Temporary Seasonal Date you can start* Month Day Year Are you employed now?* Yes No Have you ever applied for a position at Emergency Ice INC. before?* Yes No Are you on lay-off and subject to recall?* Yes No Will you travel if job requires?* Yes No Will you relocate if position requires it?* Yes No Will you work overtime if required?* Yes No Are you able to meet the attendance requirements of this position?* Yes No Have you ever been denied a bond required for employment or denied a security clearance?* Yes No Have you been convicted of a felony in the last seven (7) years?* A conviction does not constitute an automatic bar to employment unless relevant to the type of employment. Yes No EDUCATION Academic Currently AttendingName & Location of School # of Years Completed Did you Graduate? Yes No Subjects Studied Last CompletedName & Location of School # of Years Completed Did you Graduate? Yes No Subjects Studied Trade/Other Currently AttendingName & Location of School # of Years Completed Did you Graduate? Yes No Subjects Studied Last CompletedName & Location of School # of Years Completed Did you Graduate? Yes No Subjects Studied VOLUNTARY AFFIRMATIVE ACTION INFORMATION We comply with government regulation including Affirmative Action. In an effort to comply with requirements regarding government record keeping and other legal obligations, we ask that you complete this data survey. Your cooperation is appreciated. Please be advised that your survey is considered confidential information that will not be used in any employment matters. Sex* Male Female Race / Ethnic Group* Hispanic / Latino Black / African American White | American Indian / Alaskan Native Asian Pacific Islander / Native Hawaiian Two or more races SPECIAL NOTICE TO VIETNAM VETERANS, DISABLED VETERAND AND INDIVIDUALS WITH PHYSICAL OR MENTAL HANDICAPS OR DISABILITIES: Government contractors subject to the Vietnam Era Veterans Readjustment Act of 1974 and the Rehabilitation Act of 1973 are required to take affirmative action to employ and advance in employment qualified disabled veteran and veteran of the Vietnam Era, and qualified handicapped individuals. PLEASE CHECK IF ANY OF THE FOLLOWING ARE APPLICABLE: VIETNAM ERA VETERAN DISABLED VETERAN HANDICAPPED INDIVIDUAL This information is used to satisfy the Affirmative Action requirements of section 503 of the Rehabilitation Act or necessitated by another federal law or regulation. SKILLS AND QUALIFICATIONS Summarize special skills and qualifications acquired from employment or other experiences that may qualify you to work with our company:* FORMER EMPLOYERS List below, your last two employers, starting with the most recent one first. Employer #1 Date Employed From* Month Day Year Date Employed To* Month Day Year Name Previous Employer* First Last Address of Previous Employer* Street Address Address Line 2 City Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Armed Forces Americas Armed Forces Europe Armed Forces Pacific State ZIP Code Salary* Job Title* Reason for Leaving* Employer #2 Date Employed From* Month Day Year Date Employed To* Month Day Year Name Previous Employer* First Last Address of Previous Employer* Street Address Address Line 2 City Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Armed Forces Americas Armed Forces Europe Armed Forces Pacific State ZIP Code Salary* Job Title* Reason for Leaving* FORMER SUPERVISORS List below, three supervisors for whom you have worked at some point during the last five years. Name* Address* Phone Number* Years Acquainted* Name* Address* Phone Number* Years Acquainted* Name* Address* Phone Number* Years Acquainted* FOREIGN LANGUAGES List any foreign languages skills that you have and check the box(es) that best describe your capabilities. Language Speak Fluent Good Fair Read Fluent Good Fair Write Fluent Good Fair CONDITIONS OF EMPLOYMENT I give the Company the right to investigate all references and to secure additional information about me, if job related. I hereby release from liability the Company and its representatives for seeking such information and all other persons, corporations or organizations for furnishing such information. It is understood and agreed upon that any misrepresentation or omission by me in this application will be sufficient cause for cancellation of this application and/or separation from the Company's service if I have been employed. Furthermore, I understand that just as I am free to resign at anytime, the Company reserves the right to terminate my employment at anytime. with or without cause and without prior notice. No supervisor or other representative of the company (except the President of eEmployers Solutions, Inc.) has the authority to enter into any agreement for employment for any specified period of time, or to make any agreement contrary to the above. Reporting to work with impaired abilities; or the possession, consumption or distribution of drugs or alcohol on Company or Client premises and/or worksites, she be grounds for disciplinary action, including discharge. A condition of employment includes a willingness on the part of the applicant or employee to agree to physical examination, and/or substance testing, if requested by the Company. We are committed to operating a drug free workplace. Violations of our drug and alcohol policy may result in dismissal. The Company is an Equal Opportunity Employer. The company does not discriminate in employment and no question on this application is used for the purpose of limiting or excusing any applicant's consideration for employment on a basis prohibited by the local, state, or federal law. Any controversy of any kind arising between the parties under this agreement or otherwise (or any agent, officer, director or affiliate of any party), including but not limited to common law, statutory, tort or contract claims, will be submitted to mediation and, failing settlement in mediation, to binding arbitration, in accordance with the rules of the American Arbitration Association. Arbitration shall be conducted in San Antonio, Texas. Each party will select one person to serves as arbitrator. Those arbitrator will in turn select a single arbitrator to hear the matter. Each party is responsible for its own costs and expenses and will share equally the cost and expenses of the Arbitrator. The arbitration will be subject and agree that this agreement involves matters affecting interstate commerce. U.S.C., Section 1-et seq. The parties hereto stipulate and after that this agreement involves matters affecting interstate commerce. This application is current for on 60 days. At the conclusion of this time, if I have not heard from the Company and still wish be considered for employment, it will be necessary to fill out a new application. I have carefully read the above Conditions of Employment and I understand and agree to the terms.* Yes No Signature (Type Your Full Name)* First Middle Last Date* Month Day Year As a Dallas ice company, Emergency Ice focuses on fast, reliable, superior ice service to the Dallas-Fort Worth Metroplex. Ice is a critical success component for restaurants, bars and events. Our customers come first! Business Hours Monday-Friday: Open 24 hours Saturday: Open 24 hours Sunday: Open 24 hours Contact Us Address: 8700 Diplomacy Row, Dallas, TX 75247 Phone: 1.972.988.0577 Fax: 1.214.631.3536 Email: info@emergencyice.com Copyright © 2019 Emergency Ice | Web design by Big D Creative. Search engine optimization by Dallas SEO Dogs.