August 2021

Thank You for your interest in joining the Scelzi Team. 
We currently manage and staff locations in:
•	Fresno, Ca.
•	Riverside, Ca.
•	LaSalle, CO
•	Shafter, Ca.

We will soon open other locations as well. 
We are glad you are considering joining our growing company. 

BEFORE YOU PROCEED, 
Please read our privacy and data protection policy located here
https://www.seinc.com/PRIVACY-POLICY.htm

Our JOB APPLICATION begins on the next page 

SCELZI ENTERPRISES, INC.
APPLICATION FOR EMPLOYMENT	
Please provide complete and legible information. An incomplete application may affect your consideration for employment. If necessary, attach a separate sheet for additional information.
Scelzi is committed to a policy of Equal Employment Opportunity and will not discriminate against an applicant or employee on the basis of race, color, religion, creed, national origin, ancestry, sex, gender, age, physical or mental disability, veteran or military status, genetic information, sexual orientation, gender identity, gender expression, marital status, or any other legally recognized protected basis under federal, state, or local laws, regulations, or ordinances. The information collected by this application is solely to determine the individual’s knowledge, skills, experience and suitability for employment.
Applicants with disabilities may be entitled to reasonable accommodation under the Americans with Disabilities Act, California's Fair Employment and Housing Act, and local laws. A reasonable accommodation is a change in the way things are normally done which will ensure an equal employment opportunity without imposing undue hardship on Scelzi. Please inform the company's personnel representative if you need assistance completing any forms or to otherwise participate in the application process.
Your application will be active for 30 days. If you are not hired during that time period, but wish to continue to be considered for available positions, you must complete a new application.

I had the opportunity to review the Scelzi Privacy Policy before completing this form    Yes												  	  No

PERSONAL INFORMATION:	Date: __________________
Name:	
	Last	First	Middle
Phone Number: ______________________________
Referred By: ___________________________	Email: ______________________________
All Names Used In the Past:
	
	Last	First	Middle
Address:	
	Street	City	State	Zip
To prevent conflicts of interest, relatives of employees may not work in a direct supervisory relationship, or in job positions in which a conflict could arise. Does your application for the position involve such a conflict?  Yes		    No
	
EMPLOYMENT DESIRED:
Position: 		Date You Can Start:	
Desired Location: 	
Expected Rate of Pay? 		Are You Employed Now? 	
If So, May We Contact Your Present Employer? 	
Have You Ever Worked for this Company? 		If So, When? 	
Have You Ever Applied to this Company? 		If So, When? 	
Are you available to work (circle all that apply)?
Full-time	Part-time	6am to 2:40 pm	2:30 pm to 11:10 pm 	
	Weekend	Overtime		
EDUCATION AND SKILLS:
	Elementary School	High School	Undergraduate College/University	Graduate/ Professional	
School Name and Location					
Years Completed	4	5	6	7	8	9	10	11	12	1	2	3	4	1	2	3	4	
Diploma/Degree				
Describe Course of Study	
Describe any specialized training, apprenticeship, skills or extra-curricular activities that are relevant to the job for which you are applying		
Describe any honors, scholarships, appointments or awards you have received		
State any additional information you feel may be helpful to us in considering your application		

List professional, trade, business or civil activities and offices held.  You may exclude information that would reveal sex, race, religion, national origin, age, ancestry, or disability or other protected status or personal information: 	

	
List any job-related professional or technical organizations to which you belong. You may exclude information that would reveal sex, race, religion, national origin, age, ancestry, or disability or other protected status or personal information:

				

List any professional or vocational certificates, licenses, or registrations that you currently hold or have held in the past:

	

U.S. Military or Naval Service? 	¨ No	¨ Yes	Rank: 	
Citations/Awards: 	
List any job-related skills that you learned while in the U.S. Military or Naval Service:

	
If you are applying for a position which requires driving:
Driver's License Information:
Do you have automobile insurance as required by state law?  ¨ No		¨ Yes
State: 		Number: 		Expiration Date: 	
Restrictions or Suspensions (respond fully if driving is required by the job for which you are applying):

GENERAL INFORMATION:
What do you expect to be doing in five years?	What would your last manager/supervisor say about your job performance?	
What has been your favorite/most interesting job?	What made it enjoyable/interesting?	
What job did you dislike most?	Why did you dislike it?	
Have you entered into any agreements with any former employer (for example, an agreement not to compete or confidentiality agreement) that may impact your ability to work for the Company? 
¨ No 	¨ Yes

Are you over 18 years of age? 		¨ No	 ¨ Yes

Workplace violence is any conduct which is sufficiently severe, offensive, or intimidating to cause an employee to reasonably fear for the employee’s personal safety or the safety of the employee’s family, friends, associates, and/or property such that employment conditions are altered or a hostile, abusive or intimidating work environment is created. Have you ever been disciplined, warned, or terminated from employment due to workplace violence? 
¨No	  ¨ Yes

Are you able to perform the essential duties of the position for which you are applying, including regular attendance, with or without reasonable accommodation(s)?
¨ No	  ¨ Yes

FORMER EMPLOYERS:
Start with your present or last job.  Include any job-related military service assignments and volunteer activities.
1.	Employer:	Dates Employed	Work Performed	
Address	From	To	
	
Telephone Number(s)
		
Job Title 

	Supervisor
		
Reason For Leaving: 

2.	Employer:	Dates Employed	Work Performed	
Address	From	To		
Telephone Number(s)
		
Job Title

	Supervisor
		
Reason for Leaving	
3.	Employer:	Dates Employed	Work Performed	
Address	From	To		
Telephone Number(s)
		
Job Title

	Supervisor
		
Reason for Leaving	

Have you been discharged or asked to resign from a position or a job? 	¨ No	  ¨ Yes
Explain reasons:

	

I understand and acknowledge the following:
1.	If I am offered employment, I will, as a condition of employment, be required to submit proof of my identity and legal right to work in the U.S.
2.	I understand that, if I am employed, any false statement, misrepresentation, or omission of facts on this application or on any supporting documents, regardless of when discovered to be false or omitted, may result in my immediate dismissal.
3.	I understand that I will be required to possess a current and valid California driver's license if my job requires me to drive in the course of my work.
4.	I agree that, if I am offered a position, it will be offered on condition that my employment shall be at will and for no definite period, and that my employment may be terminated at any time with or without cause and with or without prior notice.  I understand that, except for an authorized representative of Scelzi Enterprises, Inc., no supervisor or manager may alter or amend the above conditions.  Only the authorized representative of the Company has authority to enter into any agreement for employment for any specified period of time or to make any agreement contrary to the foregoing.
5.	I understand and agree that, if I am offered a position, it will be a conditional offer based on my successful passing of both a drug and alcohol screen and job related medical examination.
6.	I agree that I will settle any and all previously unasserted claims, disputes, or controversies arising out of or relating to my employment, my application or candidacy for employment, and/or cessation of employment with Scelzi Enterprises, Inc., exclusively by final and binding arbitration before a neutral Arbitrator (pursuant to the Company’s Alternative Dispute Resolution Policy).  By way of example only, such claims include claims under federal, state, and local statutory law, such as the Fair Employment and Housing Act, Age Discrimination in Employment Act, Title VII of the Civil Rights Act of 1964, as amended, including the amendments of the Civil Rights Act of 1991, the Americans With Disabilities Act, the law of contract and the law of tort.
7.	If I am offered employment, I will, as a condition of employment furnish proof that I am over 18 years of age.
8.	I agree that, if I am offered employment, I will be required to conform to the rules and regulations of the Company.
9.	I authorize investigation of all statements contained in this application and any supporting documents.  I authorize the Company to secure information about my experience from former employers, educational institutions, government agencies, or any references I have provided, and for those parties to provide information concerning my experience and I hereby release all parties from any liability arising from such investigation.
10.	I understand that no supervisor or manager may alter or amend the conditions set forth in paragraphs one (1) through nine (9) above.  I understand that the foregoing conditions can only be altered or amended by a written agreement signed by an authorized representative of the Scelzi Enterprises, Inc.

Date: 			
						Signature