Step 1: Employment Details

Note: This application form is intended for use in evaluating your qualifications for employment. This is not an employment contract. A background check, additional testing of technical / job related skills, pre-employment physical exam, as allowed by law and/or for the presence of illegal substances may be required as a condition of employment.
Job Application Date	Date
Position Desired *	Class A Driver (Form02262024) Diesel Truck Mechanic (Form08172023) Field Engineer – Mid-Atlantic Division (Form03042022) Heavy Equipment Mechanic – Mid-Atlantic Division (Form092722) Heavy Equipment Operator (Form03282022) Rigging/High Burner – Working in Multiple States (Form03042022)
First Name *
Middle Initial
Last Name *
Street Address *
APT or Unit Number
City *
State *	-select- AL AK AR AZ CA CN CO CT DC DE FL GA HI IA ID IL IN KS KY LA MA MD ME MI MN MO MS MT NC NE NH NJ NM NV NY OH OK OR PA PR RI SC SD TN TX UT VA VI VT WA WE WI WV WY
Zip Code *
Telephone(Main) *
Telephone(Secondary)
Email Address *

Are you legally authorized to work in the United States?	Yes	No
(If offered employment, you will be required to verify your eligibility to work in the United States.)

Referral Source
Current Employee
Other(Please Specify)

Which type of organization directed you to this job?  -select- Diversity organization Historically black college and university Minority organization One-stop center People with Disabilities organization State workforce University or college Veteran organization Women organization N/A

Step 2: Employment History Details

Education
Highest level of education completed *	Select or type... 12 years or less High School Diploma GED Bachelor's Degree Master's Degree PhD
Name Of Institution
Attach a Resume:

Job Related Knowledge, Skills, Abilities, Licenses, Certificates & Professional Memberships
Check any licenses or certificates you possess:
10 Hr OSHA	Crane Safety	Scaffold
30 Hr OSHA	Crane Signal Person	HAZWOPER
First Aid/CPR	Rigging	Asbestos Training/License
Please list additional job-related knowledge, skills, abilities, licenses, certifications, and professional Memberships that relate to the position you are applying for:

Employment History(Most Recent Job)
Employer		Start Date
Job Title		End Date
Supervisor		Phone No
Reason for leaving

Employment History(Previous Job)
Employer		Start Date
Job Title		End Date
Supervisor		Phone No
Reason for leaving

I hereby certify that the facts set forth in the above employment application are true and complete to the best of my knowledge and authorize Brandenburg Industrial Service Company (Brandenburg) to verify their accuracy and to obtain reference information on my work performance. I hereby release Brandenburg from any/all liability of whatever kind and nature which, at any time, could result from obtaining and making an employment decision based on such information. I understand that, if employed, falsified statements of any kind or omissions of facts called for on this application shall be considered sufficient basis for dismissal. I further understand that no manager or representative of Brandenburg, other than the President, has any authority to enter into any agreement with me for employment for any specified period of time or to make any agreement different from or contrary to any Company policy. I further understand that any such agreement, if made, shall not be enforceable unless it is in writing and signed by me (or my authorized representative) and by Brandenburg’s President. I understand that should an employment offer be extended to me and accepted that I will fully adhere to the policies, rules and regulations of employment with Brandenburg. However, I further understand that neither the policies, rules, regulations of employment or anything said during the interview process shall be deemed to constitute the terms of an implied employment contract. I understand that any employment offered is for an indefinite duration and at will and that either I or Brandenburg may terminate my employment at any time with or without notice or cause.
Applicant Signature	Clear ↓

Step 3: Voluntary Self Identification

Note: Brandenburg is a Government construction contractor or subcontractor subject to laws including Executive Order 11246 (EO 11246) and the Vietnam Era Veterans' Readjustment Assistance Act of 1974 (VEVRAA). These laws require that covered Government contractors and subcontractors take affirmative action to employ and advance in employment applicants and employees without regard to protected characteristics. Brandenburg is also subject to certain governmental record keeping and reporting requirements. In order to comply with these requirements, we invite you to check the appropriate boxes below. Submission of this information is voluntary and refusal to provide it will not subject you to any adverse treatment. The information you provide will be kept confidential and will only be used in ways that are consistent with the law.

Gender (Choose one) *

Select.... Male Female I do not wish to disclose

Race/Ethnic Identification

Definitions of race/ethnicity are below (as defined by the Equal Employment Opportunity Commission) Hispanic of 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 Other 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. American Indian 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 maintain tribal affiliation or community attachment. Two or More Races (Not Hispanic or Latino) - All persons who identify with more than one of the above five races.

Choose one *

Select.... Hispanic or Latino White (Not Hispanic or Latino) Black or African American (Not Hispanic or Latino) Native Hawaiian or Other Pacific Islander (Not Hispanic or Latino) Asian (Not Hispanic or Latino) American Indian or Alaska Native (Not Hispanic or Latino) Two or More Races (Not Hispanic or Latino) I do not wish to disclose

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 below, please indicate by choosing the appropriate option below.

Veteran Status

Definitions of Veteran Status Disabled Veteran : (1) 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 (2) a person who was discharged or released from active duty because of a service-connected disability. Recently separated veteran : 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. Active duty wartime or campaign badge veteran : 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. Armed Forces service medal veteran : 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 (61 FR 1209).

Choose one *

Select.... I am a Protected Veteran I am not a Veteran I do not wish to disclose

Step 3a: Voluntary Self-Identification of Disability

Form CC-305 Page 1 of 1			OMB Control Number 1250-0005 Expires 04/30/2026
Name:		Date:		Date
Employee ID:                         (if applicable)

Why are you being asked to complete this form?

We are a federal contractor or subcontractor. The law requires us to provide equal employment opportunity to qualified people with disabilities. We have a goal of having at least 7% of our workers as people with disabilities. The law says we must measure our progress towards this goal. To do this, we must ask applicants and employees if they have a disability or have ever had one. People can become disabled, so we need to ask this question at least every five years.

Completing this form is voluntary, and we hope that you will choose to do so. Your answer is confidential. No one who makes hiring decisions will see it. Your decision to complete the form and your answer will not harm you in any way. If you want to learn more about the law or this form, visit the U.S. Department of Labor’s Office of Federal Contract Compliance Programs (OFCCP) website at www.dol.gov/ofccp.

How do I know if I have a disability?

A disability is a condition that substantially limits one or more of your “major life activities.” If you have or have ever had such a condition, you are a person with a disability. Disabilities include, but are not limited to:

Please check one of the boxes below:

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.

For Employer Use Only Employers may modify this section of the form as needed for recordkeeping purposes. For example: Job Title:     Date of Hire:

Step 4: Applicant Notices

Brandenburg participates in the E-Verify program. DOL Federal Contractor Posters provide details on everyone’s Right to Work, Workplace Discrimination is Illegal & Pay Transparency Nondiscrimination Provisions. Brandenburg is a drug-free workplace. Employees are prohibited from manufacturing, distributing, dispensing, possessing, using, or being under the influence of illegal drugs, inhalants, or controlled substances in the workplace. Any employee who violates this policy will be subject to disciplinary action up to and including termination of employment. Please click "Finish" at the bottom of the page to submit your application