Event Employment Form

Please answer ALL questions and give details/explanations of answers. There are no wrong answers, this information is to help us build strong cohesive teams with similar personalities, interest, etc., and so we can have a compliment of strengths and weaknesses.

"*" indicates required fields

Name*

First Last

Email*

Date of Birth*

Legal Mailing Address*

Street Address Address Line 2 City State ZIP Code

Physical Location*

Street Address Address Line 2 City State ZIP Code

Nearest Commercial Airport*

Phone Number (Cell)*

Do you have a valid driver's license?*

Yes

State*

Class*

Do you have a clean driving record?*

Yes

Due to the industry we are in, we frequently work with Federal, State, and Local governments. The following questions will provide us additional information to understand potential scope of employment within the company. Individuals that present certain information are not excluded from any potential employment. Porta Kleen remains an Equal Opportunity Employer.

Have you ever been convicted of a felony?*

Yes

If yes, please explain.

Are you currently awaiting a ruling, judgement or any legal response that would affect your ability to work within certain operations?*

Yes

By checking this box, you agree and understand that Porta Kleen reserves the right to pre-screen your history through a background check.*

Yes, I understand and agree.

As we do not have the ability to predict when, where, or why we are dispatched to an operation, there are many factors that need to be taken into consideration when applying for this job, as well as our ability to put you in a position that will not endanger yourself, and will not put the company at risk. The following questions will give you an understanding of the requirements necessary for operation, and will allow us to determine the best fit for you. Please answer questions truthfully. These questions are CRITICAL to operational methods, staffing, and scope. If found that these questions are not answered truthfully, Porta Kleen fully reserves the right to handle the situation as they see fit.

By checking this box, you agree and understand that these questions need to, and will be answered truthfully, to the best of your extent.*

Yes, I understand and agree.

By checking this box, you agree and understand that Porta Kleen will do their best to provide positions that are desired for the individual. There is no guarantee of designation to the desired position. If hired, I am hired as an attendant, and am able, willing, and capable to perform all duties necessary.*

Yes, I understand and agree.

What temporary, seasonal, part-time position(s) are you interested in?*

Attendant

Driver

Maintenance

Job Type*

Events

Fire Camps

Disaster events are extremely hard to predict. There is really no logical time frame to judge how long an incident will last. Fires can burn for a few days or several weeks.

By checking this box, you understand the following: Music Events can be for a few days up to a few weeks. These events are typically scheduled far in advance and we will have a fairly solid time-frame of deployment. For Fire Operations - WE REQUIRE A TWO WEEK COMMITMENT TO BE CONSIDERED FOR DEPLOYMENT. If an incident does not extend the full two weeks, YOU WILL ONLY BE PAID FOR THE TIME DEPLOYED (TIME OF DEPARTURE - TIME OF RETURN TO HOME).*

Yes, I understand and agree.

By checking this box, I understand and agree that Porta Kleen will pay for return transport home for approved events/situations: Operational Demobilization, Logistical Needs, or other approved circumstances (based upon Porta Kleen’s discretion). If I choose to go home prior to one of these approved events, Porta Kleen will pay for my return home, although this will result in immediate demotion on the priority list up to and including complete removal from consideration of dispatch.*

Yes, I understand and agree.

Do you have any physical limitations that may prevent you from walking, climbing, kneeling, crouching, bending, or lifting up to 20 lbs for short periods of time?*

Yes

If yes, please explain*

Are you currently taking any medications that you would NOT be able to have at least a 30 day supply on hand at the time of deployment? *PLEASE NOTE: THERE IS NO GUARANTEE THAT REFRIGERATORS WILL BE AVAILABLE FOR MEDICATION THAT MUST STAY CHILLED.*

Yes

Do you require the use of CPAP, medical aid, or other device? Porta Kleen will make accommodations if available and necessary, although there is no guarantee due to circumstances.*

Yes

Are you currently under a physicians’ care that may or may not affect your work? If yes, is there restrictions or limitations as to your work eligibility?*

***Please note that undisclosed medical information resulting in lack of performance, damage to property or injury during the course of deployment will result in disciplinary action up to and including termination and possible litigation.

Yes

If yes, please explain*

Do you have any issues with flying, buses or other forms of transportation?*

Yes

If yes, please explain*

During travel, there are some things that we do not pay for during the booking (baggage and meals). We pay a travel day per diem of $50 which will help with the cost of those items. Once you arrive at camp, there should be no expenses for you except the very rare occasion when we arrive before the catering and there may be a meal or two that you will have to provide for yourself (this will also be paid back to you with a per diem entry – Breakfast $7.50, Lunch $7.50, Dinner $15.00). By checking this box, you agree to come to an assignment prepared to cover any expenses required for a short time.*

Yes, I understand and agree

Conditions at events and fire incidents may vary from incident to incident, sometimes during a deployment. Do you have any physical or medical issues with any of the following:*

100° (or higher) temperatures

Dry or Arid Conditions

Smoke

Rain/Sleet/Snow/Fog

High Altitudes

40° (or less) temperatures

Damp Conditions

Dust

Mud or Clay

High Winds

None of the above

If you checked any of the boxes above, please explain:*

We employ a diverse group of personnel throughout our season. We endeavor to create teams that work with each other in an efficient, cohesive, and friendly manner. Please list any concerns or issues you feel may arise for you within a diverse group of people.

Please list any other pertinent information you feel we may need to be aware of for health, safety or other purposes.

Please list any known unavailable dates you may know of throughout the year so we can track who is available and when.

As a Federal Contractor we follow the mandates of Title VII of the Civil Rights Act of 1964. No applicant can or will be discriminated against in the hiring, promotion, discharge, pay, fringe benefits, job training, classification, referral, or other aspects of employment, on the basis of race, color, religion, sex (including pregnancy), national origin, age, or disability. We are an Equal Opportunity Employer. Porta Kleen must explicitly state: BY SUBMITTING THIS APPLICATION, THERE IS NO GUARANTEE OF ANY EMPLOYMENT. THE POSITION I AM APPLYING FOR IS AN ON-CALL, AS NEEDED POSITION. By checking this box, you agree and understand the policies that Porta Kleen follows as an Equal Opportunity Employer.*

Yes, I understand and agree.

Name

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