Driver

BBB-**** - Safety Ambassador

Jan **, ****

Applicant Statement

Applicant Statement

I certify that the information provided in this employment application process (and any subsequent information presented throughout the hiring process) is true and complete. I understand that any false information or significant omissions may disqualify me from consideration for employment and may be justification for my dismissal from employment, if discovered at a later date. I authorize an investigation of all statements contained in this application (and any subsequent information presented throughout the hiring process) as allowed by applicable law. I also authorize the company to contact my present employer (unless otherwise noted in this application form), past employers and listed references for any lawful reason. I authorize any person, school, current and/or previous employer and organizations named in this application form (and any subsequent information presented throughout the hiring process) to provide the company with relevant information and opinion that may be useful to the company in making a hiring, or termination decision, and I release such persons and organizations from any legal liability in making such statements.

I understand that neither this document nor any offer of employment from the employer constitutes an employment contract with the exclusion of the Arbitration Agreement, which is a binding contract. I understand that if I am hired, either the company or I may terminate my employment at will for any reason with or without cause. I have read, understand and agree with the Applicant Statement. Yes Judy Gorman

Friday, January 24, 2025 at 02:29 PM

Drug Free Workplace

Drug Free Workplace

Block by Block is committed to providing a safe and drug free work environment for all employees. To help ensure a safe working environment, job applicants may be asked to provide body substance samples (such as urine and/or blood) to determine the illicit or illegal use of drugs, unless otherwise prohibited by law. Employees may also be subject to drug and/or alcohol testing as described below, unless otherwise prohibited by law. I understand that if I am required to submit to a pre-employment drug test in order to determine my qualifications for employment, it must be completed within 24-48 hours of the offer of employment. Any offer of employment will be contingent on a negative drug test result being received by Block by Block. Refusal to test, or failure to test within 48 hours of an offer of employment will result in the offer of employment being revoked. I understand that if I am hired prior to the completion of the required drug test, my continued employment is contingent upon a negative drug test result. I understand that it is a condition of employment for all employees to submit to drug and/or alcohol testing, upon request, under the following circumstances unless otherwise prohibited by law:

Where there is reasonable suspicion to believe that an employee is under the influence of alcohol or illegal drugs. When an employee is involved in an on-the-job accident where personal injury or damage to company property or property of the Block by Block customer occurs. As part of the random drug and alcohol testing program. As part of a follow-up program for treatment for substance abuse. I further understand that Block by Block has designated a third party to act as its "Designated Agent" for the purpose of receiving and processing individual's drug and alcohol test results. I understand the company's Designated Agent will receive my drug and alcohol test results directly from the company's drug testing laboratories and alcohol testing facilities, and will process and report such test results to Block by Block in a confidential manner. I understand that refusal to submit to pre-employment drug testing or post-employment drug and/or alcohol testing may result in disciplinary action, up to and including termination of employment.

I understand that if a positive test result is received, my employment with Block by Block will be terminated, unless otherwise prohibited by law. The results of such tests will be used solely to determine my qualification for employment or continued employment and will be disclosed only to the proper company representatives and may be supplied to the appropriate facility/location personnel if I am hired. I understand and authorize the testing procedures. I have read and accept the terms of the Drug Free Workplace Statement. Yes Judy Gorman

Friday, January 24, 2025 at 02:29 PM

Arbitration Agreement

Arbitration Agreement

Notice to all Applicants and Employees of Block by Block Individuals who wish to be considered for employment by Block by Block ("the Company") must read and accept the terms of the following Dispute Resolution Agreement. If you desire to do so, you may stop the process at this point and take the time to review these materials further. You must, however, complete the online Agreement, along with your application, if you wish to continue the application process and if you wish to be employed by the Company. All persons who apply for employment with the Company after November 30, 2011, and those who become employed as a result of such application, are required to agree to the Dispute Resolution Agreement below. Dispute Resolution Agreement

You and the Company recognize that differences may arise between you that cannot be resolved without the assistance of an outside party. Both you and the Company agree to resolve any and all claims, disputes or controversies arising out of or relating to your application for employment, your employment with the Company, and/or the termination of your employment exclusively by arbitration to be administered by a neutral dispute resolution agency agreed upon by the parties at the time of the dispute. If you and the Company cannot agree, the American Arbitration Association ("AAA") will administer the arbitration pursuant to its applicable Rules. Copies of AAA's Rules are available on AAA's website (www.adr.org). Some, but not all, of the types of claims covered are: unpaid wages, overtime, or other compensation; discrimination or harassment on the basis of race, sex, age, national origin, religion, disability or any other unlawful basis; breach of contract; unlawful retaliation; wrongful discharge; employment-related tort claims such as defamation; and claims arising under any statutes or regulations applicable to employees or applicable to the employment relationship, such as the Age Discrimination in Employment Act, the Family and Medical Leave Act, or the Fair Labor Standards Act. Claims not covered are those constituting sexual harassment or sexual assault disputes as defined by the Federal Arbitration Act, and those seeking injunctive or declaratory relief due to allegations of unfair competition, unfair business practices, the unauthorized disclosure of trade secrets or confidential information, or the breach of covenants restricting the business activities of the Company or employees. This Agreement does not affect or limit Employee's right to file an administrative charge with a state or federal agency such as the National Labor Relations Board or the Equal Employment Opportunity Commission, and it does not cover claims relating to whistleblowers and/or unlawful retaliation arising under the Sarbanes-Oxley Act. You and the Company agree that this Agreement shall be enforceable pursuant to and interpreted in accordance with the provisions of the Federal Arbitration Act. The Arbitrator shall have the authority to award the same damages and other relief that would have been available in court pursuant to applicable law. The Arbitrator will have the authority to limit discovery and other pretrial processes to what is necessary for a prompt and inexpensive resolution of the dispute. Absent a showing of substantial need by either party or an inability to pursue or defend certain claims, the Arbitrator shall limit discovery to 25 interrogatories/document requests per party and to two depositions per party. It is expected that the arbitration hearing will be held within 180 days of the appointment of the Arbitrator. The AAA Rules will govern the allocation of costs between the parties and the course of the proceedings unless otherwise agreed. The Arbitrator shall not have the authority to add to, amend, or modify existing law or to alter the at-will status of the relationship between you and the Company. Because this Agreement is intended to resolve the particular dispute as quickly as possible, the Arbitrator shall not have the authority to consolidate the claims of other employees into a single proceeding, to fashion a proceeding as a class, collective action, or representative action, or to award relief to a class or group of employees. The Arbitrator shall have the authority to consider and rule on dispositive motions such as motions to dismiss or motions for summary judgment in accordance with the standards and burdens generally applicable to such motions in federal district court, except that the Arbitrator may establish appropriate and less formal standards and procedures for such motions at the Arbitrator's discretion consistent with the expedited nature of arbitration proceedings. The Arbitrator may issue subpoenas to compel the attendance of witnesses at the arbitration hearing and to compel the production of documents during discovery and shall do so upon reasonable request of either party. The Arbitrator shall have the exclusive authority to resolve any dispute relating to the interpretation, applicability, enforceability, or formation of this Agreement, including, but not limited to, any claim that any part of this Agreement is unenforceable, void, or voidable. For the purposes of the scope of the obligation to arbitrate, "Company" shall include Block by Block, and all subsidiary companies, related companies, trade names, and alleged joint employers, as well as their respective offices, directors, managers, and employees (current and former). If any provisions of AAA's Rules or of this Agreement are determined by the Arbitrator or by any court of competent jurisdiction to be unlawful, invalid, or unenforceable, such provisions shall be severed or modified so that the Agreement may be enforced to the greatest extent permissible under the law. All remaining terms and provisions shall continue in full force and effect. This Agreement may be modified or terminated by the Company after thirty days written notice to you. Any modifications or terminations shall be prospective only and shall not apply to any claims or disputes that are pending in arbitration or that have been initiated by either party. SPECIAL NOTE: This Agreement and the Rules referenced above are important documents that affect your legal rights. You should familiarize yourself with and understand them, and, accepting below, you acknowledge that you have had the opportunity to do so. You may wish to seek legal advice or to consult with private legal counsel before signing this Agreement. By acknowledging and by accepting employment with the Company if it is offered, you agree to be bound to this Dispute Resolution Agreement, as does the Company. You understand that, as more fully set forth above, you must arbitrate any and all employment-related claims against the Company and that you may not file a lawsuit in court in regard to any claims or disputes covered by this Agreement.

I have read and accept the terms of the Arbitration Agreement. Yes Name on File: Judy Gorman

Signed: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Judy Gorman Accepted

Date/Time Signed (will auto populate in EST): .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Jan 24, 2025 02:29 pm Waiver Agreement

Waiver Agreement

Notice to all Applicants and Employees of Block by Block Individuals who wish to be considered for employment by Block by Block ('the Company") must read and accept the terms of the following Waiver Agreement ("Agreement"). If you desire to do so, you may stop the process at this point and take the time to review these materials further. You must, however, complete the online Agreement, along with your application, if you wish to continue the application process to be employed by the Company. All persons who apply for employment with the Company after July 1,2018, and become employed as a result of such application, are required to agree to this Agreement. Waiver of Third Party Claims Waiver Agreement

I as a potential employee of Company agree and understand that state Workers' Compensation statutes cover work-related injuries that may be sustained by me while I am employed by Company. If at any time during my employment with Company I am injured on the job, I understand that I am required to notify my manager immediately. The manager will provide me with information that informs me of my state's Workers' Compensation law as it pertains to seeking medical treatment. This will ensure that reasonable medical treatment for a work related injury will be paid for by the Company's insurance.

As a result, and in consideration of Company offering me employment, I hereby waive and forever release any and all rights I may have to: Make a Claim, or

File a Lawsuit, or

Seek to recover damages or losses from or against any customer (and the employees of any customer) of Company to which I may be assigned, arising from or related to any injures which are covered under my state's Workers' Compensation law. For purposes of this scope of the obligation to waive third party claims, "Company" shall include Block by Block, and all subsidiary companies, related companies, trade names and alleged joint employers, as well as respective officers, directors, managers and employees (current and former). SPECIAL NOTE: This Agreement is an important document that affects your legal rights. You should familiarize yourself with and understand them in their entirety, and, accepting below, you acknowledge that you have had the opportunity to do so. You may wish to seek legal advice or to consult with private legal counsel before signing this Agreement. By acknowledging and by accepting employment with the Company if it is offered, you agree to be bound to this Waiver of Third Party Claims Agreement, as does the Company. I have read and accept the terms of the Waiver Agreement. Yes Judy Gorman

Friday, January 24, 2025 at 02:29 PM

Personal Information

To move forward in the process, click on the arrow at the bottom of the page.

* = Required

** = Conditionally Required

Personal Information

Legal First Name . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Judy Preferred First Name .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

(Optional - Do not use values such as None, NA or Phone Numbers in this field.)

Judy

Legal Last Name . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Gorman Legal Middle Name .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Ann Email Address . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . **********@*****.*** Address 1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7450 N Shepherd Dr. Address 2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . City . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Houston Country . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . United States State/Province** . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Texas Zip/Postal Code . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 77091 Primary Phone . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 409-***-**** Secondary Phone . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 409-***-**** Willing to Relocate .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . No Willing to Relocate to .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Willingness to Travel .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . None General Information

Have you ever been employed by Block by Block? No

If yes, what location?** .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . From Date** . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . To Date** . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Do you have relatives employed by Block by Block? No If yes, give their names** .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Employment History

To add additional employers, click the "Add Employer" button below. The "Remove Last Employer" will delete all entries for the last employer that you have entered. Please enter your most recent employer first.

* = Required

** = Conditionally Required

Employment History

Employer 1

Type . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Current Employer** . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Connect staffing Employer Phone** .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 713-***-**** City** . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Houston Country** . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . United States State** . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Texas Start Date** . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 01/03/2018 End Date** . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . If Current, please leave blank

Start Position/Title .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Driver End Position/Title** .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Driver May We Contact?** .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Yes Job Duties . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Drive Reason for Leaving or Looking to Leave** .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Looking to Leave To add additional information, click the Add button above. When you have completed entering your information, click on the forward arrow below to move to the next page of the application. Education History

To add additional education, click the "Add Education" button below. The "Remove Last Education" will delete all entries for the last education that you have entered. Please enter your highest level of education first.

* = Required

** = Conditionally Required

Education History

Education 1

Education Level . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . HS Graduate or Equivalent School/University Name** .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Francis T. Nichols City** . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . New Orleans Country** . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . United States State/Province** . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Louisiana Major . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Graduated?** . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Yes Professional References

To add additional employers, click the "Add Professional Reference" button below. The "Remove Last Professional Reference" will delete all entries for the last reference that you have entered.

* = Required

** = Conditionally Required

Professional References

Professional Reference 1

First Name . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Last Name . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Relationship . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Company . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . City . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Country . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . State/Province** . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Phone Number** . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

(Either a phone number or email address is required) Email Address** . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Position and Wage Confirmation

JOB DESCRIPTION

JOB SUMMARY

Safety Ambassadors will patrol the city on bike as a deterrent to and being on the lookout for unwanted behavior and activity, while providing information, assistance and directions to downtown workers, residents and visitors.

ESSENTIAL FUNCTIONS

* SERVING AS A DETERRENT - Traverse the streets to circulate through assigned zone to deter unwanted activity through uniformed visible presence.

* OBSERVE AND REPORT - While on patrol be watchful for unwanted behaviors or criminal activity and report to local authorities via established communication methods. Must be able to articulate an accurate description of persons, vehicles, and other similar identifiers.

* ADDRESS UNWANTED ACTIVITIES - Ambassadors will firmly and courteously request compliance to persons violating low level quality of life crimes, such as aggressive panhandling, non- aggressive panhandling, loitering, disruptive behavior, etc.

* HOSPITALITY AND CUSTOMER SERVICE - While on patrol will go out of the way to actively acknowledge pedestrians with a friendly greeting or identify visitors in order to provide directions, information, city information or recommendations.

* STAKEHOLDER RELATIONS - Ambassadors will be responsible for making a specified number of visits to district businesses to share information and make professional contacts on behalf of the customer.

* REPORTING - Must be able to develop written Incident Reports and Property Condition Reports. As well, Ambassadors must provide a daily written report to document shift activities

* PROFESSIONALISM - Must maintain a positive, professional environment in full compliance with applicable laws, regulations, policies, procedures and overall Block by Block standards of expected professionalism.

We are proud to offer the following benefits:

Insurance: Medical with available FSA and/or HSA, Dental, Vision, Short-Term and Long-Term Disability, Life, and Accidental Death and Dismemberment, Critical Illness, and Accident. Paid time off: Vacation, Sick Time and/or PTO (Only where required by local requirements and contract agreements), Paid Leave (only where required by law), Holidays (only where required by contract agreement), Floating Holidays (only where required by contract agreement), Birthday Pay (eligible after one year of service at most locations unless otherwise stated in CBA), Jury Duty (only where required by law).

Other: 401K Retirement Savings Plan

REQUIREMENTS

PHYSICAL ABILITIES

* Must have the physical capacity to ride a bike or traverse continuously during an eight hour shift, with normal breaks (two fifteen minutes, and one thirty minute meal break).

* Must be able to work outdoors in all conditions with provided inclement weather gear. COMMUNICATION

* Must be able to speak, read, and write the English language in order to create basic reports. PAY RANGE

38,400

I have read, understand and agree with the Job Description and Pay Range. Yes eSignature

ELECTRONIC SIGNATURE: Please type your full legal name as it is listed in the document above. I testify that this statement is true to the best of my knowledge: Judy Gorman E-Signature

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Judy Gorman Accepted

Date . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

(System will autofill) Jan 24, 2025 02:29 pm

Contact this candidate