Employment Application - Tygarts Valley Sanitation

Application for Employment

Applicant: Read and sign before submitting this application.

I understand that the information in this application will be used and that prior employers will be contacted for purposes of investigation as required by Section 391.23 of the Federal Motor Carrier Safety Regulations.

Signature

Date

Name

First Middle Last

Phone

*Current Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

*If at the above residence less than 3 years, list all residences for the past 3 years.

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

*If at the above residence less than 3 years, list all residences for the past 3 years.

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

*If at the above residence less than 3 years, list all residences for the past 3 years.

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Date of Birth

(Answer only if apply for driving position)

Social Security No.

In case of emergency notify:

Name

First Last

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Phone

Position Applying for

Temporary

Part Time

Full Time

Have you worked for this company before?

Yes

If Yes, Dates:

Where?

Rate of pay

Position

Reason for leaving

Names of relatives employed by this company

Are you currently employed?

Yes

If not, how long since leaving last employment?

Who referred you?

Rate of pay expected?

EDUCATION

Highest grade completed:

College:

Last school attended

Address of Last School Attended

Street Address Address Line 2 City State ZIP Code

GENERAL

Have you ever been bonded?

Yes

(Answer only if a job requirement)

Name of bonding company

Have you ever been convicted of a felony?

Yes

If yes, please explain fully. Conviction of a crime is not an automatic bar to employment - all circumstances will be considered.

Have you ever worked for this company under another name?

Physical History

Please describe any positions, jobs or duties for which you should not be considered because of physical, medical, or mental disabilities.

For drivers only, Date of last Department of Transportation prescribed physical examination:

For drivers only, Have you ever been granted a waiver under section 391.49 of the Federal Motor Carrier Safety Regulations pertaining to the loss of foot, leg, hand or arm?

Yes

Employment Records

Note: The United States Department of Transportation requires that applicants for driving positions must advise prospective employers of positions held as a commercial driver during the past 10 year period.

Start with last or current position, including military experience, and work back.

Last or Current Employer:

Supervisor's Name:

Address:

Phone:

Position Held:

Dates:

Salary:

Reason for leaving:

Company:

Supervisor's Name:

Address:

Phone:

Position Held:

Dates:

Salary:

Reason for leaving:

Company:

Supervisor's Name:

Address:

Phone:

Position Held:

Dates:

Salary:

Reason for leaving:

CAPTCHA

Residential Trash Removal – Commercial Trash Removal

TYGARTS VALLEY SANITATION INC.

PO Box 142, Beverly, WV 26253
Phone (304)338-2003 • Fax (304)-338-2011

Additional Service Request

Customer Name

Account Holder Name

Service Address:

Mailing Address:

Phone:

Email Address:

Service Request

Date Requested

Extra Bags - Up To Six - $7.25

Special Pick Up - We will contact you back to confirm our availability.

Dump Trailer - We will contact you back to confirm our availability.

TYGARTS VALLEY SANITATION INC.

PO Box 142, Beverly, WV 26253
Phone (304)338-2003 • Fax (304)-338-2011

APPLICATION FOR NEW RESIDENTIAL SERVICE

Customer Name

Date to begin service:

Service Address:

Mailing Address:

Phone:

Email Address:

Do you prefer monthly or quarterly billing?

Monthly Quarterly

Do you run a business out of your home?

Yes No

CONTRACT GUIDELINES FOR RESIDENTIAL CUSTOMERS

We provide a weekly service for $29.14 per month or $87.42 per quarter. Under no circumstances do we break the monthly fee down to a per week amount. Our service is available to you each week and we must charge for that availability. This is an ongoing service, you cannot skip months.
If you wish to discontinue service, temporarily or permanently, a 5 day notice is required along with a completed termination form. YOU WILL BE RESPONSIBLE FOR MONTHLY PAYMENTS UNTIL SERVICE IS DISCONTINUED.
You are allowed up to 6 bags per week of your household solid waste with a 30 pound per bag weight limit.
This contract is for only your personal household waste. Combining (or setting in) with a relative, neighbor or friend is against the law and is a chargeable offense, Code of West Virginia §22C-4-10, with fines and penalties.
You will receive an annual sticker that needs to be attached to something permanent (trash can, mailbox post, stake, etc.). This sticker must be plainly seen from where your garbage sits, or garbage will not be picked up.
All waste must be securely bagged and tied. Broken Glass is to be put in a box and then placed in a bag. Hypodermic needles need to have the cap replaced and then put in a plastic container. Cardboard boxes are to be broken down and tied with a string. We do not pick up ashes, free flowing liquids (oil, paint, etc.), vehicle parts, construction and demolition material. Please have your garbage out by 7:00 AM on your pick up day which is on .
There is a thirty dollar ($30.00) Returned Check Fee. When a check or other payment is returned by the Customer’s bank service the charge will be applied. If a Customer has two returned payments within a 12-month period, we have the right to refuse any further personal checks from the Customer for at least a 12-month period.
For Major Holidays, we may have to re-schedule your pick up day. If your pick up is affected by a holiday, a schedule will be mailed to you. A special pick up for extra garbage can be done for an additional fee, call the office for more information.
I have fully read and understand all contract guidelines and responsibilities and wish to begin services as stated above.
The following is information concerning the Bulky Good Pick Up. In July 1999, the Public Service Commission of WV issued a bulky good collection. A bulky good is a large household item that is too big to fit into a bag. Examples are such as a couch, chair, stove, refrigerator, washer, dryer, television, hot water tank, or a mattress and box springs.
The following are guidelines for bulk good pick up: Only ONE item will be picked up each month. Items must not contain Freon, there is a $50.00 fee if an item picked up contains Freon. We DO NOT pick up vehicle parts, construction, and demolition material.
If you have an item and are not sure if it can be set out, please call us at (304)338-2003 or (304)338-2021 so we can find out for you.

Customer Signature

Printed Name of Customer

Date

TYGARTS VALLEY SANITATION INC.

PO Box 142, Beverly, WV 26253
Phone (304)338-2003 • Fax (304)-338-2011

CONTRACT FOR COMMERCIAL SERVICE

Date to begin service:

DUMPSTER FOR CUSTOMER'S USE ONLY - NO OUTSIDE WASTE

(OTHER BUSINESS, GROUPS OR INDIVIUALS)

PER MANDATORY DISPOSAL OF SOLID WASTE LAW CODE 20-9-9

NOTE: Refer Specifically to "USE OF THE CONTAINER" and "CONTAINER PICKUP" below

HAND LOAD COLLECTION

BAG SIZE NOT TO EXCEED 30 GALLONS - EXTRA CHARGE FOR EXCESS UP TO 8 BAGS

NOTE: Refer Specifically on second page to "HAND PICKUP"

Authorized Signature

TERMS OF PAYMENT: All bills payable on the 1st of each month. 1.5% Late Charge after 15 days. Accounts more than 30 days past due are subject to termination with no notice. All cost of collections including reasonable attorney's fees shall be added to the principal sum if legal means are required for obtaining payment for services rendered. There is a thirty dollar ($30.00) Returned Check Fee when a check or other payment is returned by the Customer’s bank. A deposit of one month service is required for all dumpsters.

TERMS AND CONDITIONS OF SERVICE AGREEMENT

GENERAL: Tygart Valley Sanitation Corporation Inc. (Contractor) agrees to furnish the solid waste collection and disposal services and/or equipment specified herein and Customer agrees to make the payments as provided for herein and abide by the terms and conditions of the Agreement.
BINDING EFFECT: This Agreement is a legally binding contract on the part of both Contractor and Customer in accordance with the terms and conditions set out herein.
TERMS OF AGREEMENT: Unless otherwise set forth on the Agreement, the original term of this Agreement shall be one year beginning with the service commencement date. This Agreement shall be automatically extended, on the same terms and conditions for additional periods of one year each unless either party, at least 60 days prior to the expiration of the original term of this Agreement or any extended term, gives the other notice in writing by certified mail or its intent to terminate this Agreement.
CHARGES AND PAYMENTS: Customer shall pay Contractor on a monthly basis for the collection and disposal service provided by Contractor in accordance with the schedule of charges shown on reverse side of this agreement. Payment shall be made by Customer within twenty (20) days following the month that service is provided. In the event that payment is not made when due, Contractor at its sole option may at any time terminate this Agreement on notice to the Customer and recover any equipment on the premises of the Customer. A late charge at the rate of 10% will be imposed on any balance not paid within the 20th of the following month service is provided. Any additional collection will be classified as an “extra pickup” and so duly charged.
DEFINITION OR EQUIPMENT: The word “equipment” as used in these Terms and Conditions shall mean all containers used for the storage of waste material.
LIABILITY FOR EQUIPMENT: Customer acknowledges that it has the care, custody and control of equipment owned by the Contractor and accepts responsibility for the equipment and its contents except when it is being physically handled by the employees of Contractor. Therefore, Customer expressly agrees to defend, indemnify and hold harmless Contractor from and against any and all claims for loss of or damage to property, or injury to or death of person or persons, resulting from or arising in any manner out of Customer’s use, operation or possession of any equipment furnished under this Agreement.
CUSTOMER DUTIES AND LIABILITY: Customer shall be responsible for the cleanliness and safekeeping of the equipment and for the environment that the equipment sets in. Therefore any and all damages created other than normal wear and tear and acts of nature would be the responsibility of the Customer. Customer shall not make any alterations or improvements to the equipment without prior written consent of Contractor. Customer shall not overload the equipment nor use it for incineration purposes, and shall be liable to Contractor for loss or damage in excess or reasonable wear and tear. All equipment furnished by Contractor for use by Customer which the Customer has not purchased, shall remain the property of Contractor and the Customer shall have no right, title, or interest in the equipment. On collection day, the Contractor’s vehicle shall have a clear access to the equipment. The equipment shall be kept clear of automobiles, snow and obstructions. Failure to comply with this will result in the container not being emptied until the following scheduled collections.
DRIVEWAYS AND PARKING AREA: Customer warrants that right of ways provided by Customer from Customer’s equipment location to the most convenient public way is sufficient to bear the weight of all of Contractor’s equipment and vehicles reasonably required to perform the service herein contracted. It is the intent of the Agreement that the Contractor shall not be responsible for damage to any private pavement or accompanying subsurface of any route reasonably necessary to perform the service herein contracted. Customer is to furnish a concrete or asphalt pad on which to place dumpster (Minimum recommended size 8’ wide plush the dumpster top dimensional length).
USE OF THE CONTAINER: The service provided to the Customer by Contractor is for the Customer’s exclusive use in Customer’s business. The Customer shall not allow waste to be placed for removal that is not generated as a part of the Customer’s business. Contractor may refuse to provide service to Customer if Customer allows waste to be placed for removal that is not generated as part of Customer’s business or the contractor may bill the customer for waste not generated as a direct part of the Customer’s business.
HAND PICKUP: Service to the Customer will be provided by hand pickups. Except for cardboard, all waste to be picked up shall be plastic trash bags not exceeding thirty gallon: For the price, volume and schedule of service agreed upon price, Contractor agrees to pick up for disposal an agreed upon number of bags bags per week. Any additional bags above this amount set out by Customer for pickup will be charged an additional fee.
CONTAINER PICKUP: Service to the Customer will be provided by mechanically lifted containers at the price, volume and schedule of service agreed upon price. In the event that Customer sets out for disposal additional bags beyond the amount that has been agreed upon, the Customer shall be charged an additional fee per bag and an additional fee for clean up around the container (Except for cardboard, all waste to be picked up shall be in thirty gallon plastic trash bags). If the amount of additional waste set out for disposal is a cubic yard or more, then Customer shall be charged the cubic yard rate set out on the front side of this agreement.
LANDFILL COST ADJUSTMENTS: The landfill charges provided for herein shall be automatically adjusted from time to time in accordance with the actual increased charges paid by Contractor to the landfill operator. Contractor shall notify Customer of the increase and forward a copy of the notice received from the landfill operator.
RATE ADJUSTMENT: Since certain expenses of Contractor may increase for reasons beyond its control, Contractor shall have the right to increase the price of the services herein specified by giving not less than 30 days prior written notice to the Customer. However, if the Customer notifies the Contractor within 15 days after date of mailing or hand delivery of such notice that it does not agree to the price increase(s) therein specified, the price(s) will not increase, but Contractor shall have the right to terminate this Agreement anytime thereafter on not less than one week’s notice to the Customer. Also rate adjustment would be made upon an approved PSC Order under the same above noted terms.
CHANGES: Changes in the Monthly Base Charge and/or other rates, the type, size and amount of equipment, and the frequency of service may be agreed to orally or in writing by the parties without effecting the validity of the Agreement. Consent to oral changes shall be evidenced by the practices and action of the parties.
WASTE WHICH MAY NOT BE DISPOSED: The Customer shall not place in the Equipment or otherwise include in any waste to be collected and hauled by Contractor, and Contractor shall not be required to accept, and may return to the Customer at the Customer’s expense, waste which Contractor may not dispose of in a municipal solid waste landfill. Examples of such waste include, but not limited to batteries, radioactive, toxic, reactive, corrosive pathological, ignitable, acidic material or materials that are a hazardous waste. We are sorry…appliances, furniture, steel, rocks, ashes, bricks, wood and Christmas trees are not to be placed in dumpsters because these items do considerable damage to our packing equipment. Call our office to make arrangements for the removal of these items which are classified as an “Extra Pickup” and so is duly charged.
DEFAULT AND REMEDIES: Neither party shall be in default hereunder, if its nonperformance is by reason of delays or circumstances beyond the party’s control, including, but not limited to, compliance with any federal, state or local law, rule or regulation, acts of God, fires, storms, work stoppage or delays, strikes or other labor disputes, transportation embargoes or delays, or inability to obtain materials, labor, equipment or transportation. Contractor shall be in default only if it fails to cure any breach of its obligations hereunder as promptly, as reasonably, as possible after receiving written notice of the breach from Customer.
If Customer fails to make any required payments when due or fails to perform its other obligations hereunder, or if Customer becomes insolvent makes an assignment for the benefit of creditors, or if a petition in bankruptcy is filed by or against customer, Contractor, in addition to its other remedies, may terminate this Agreement and without notice, demand or legal process enter upon Customer’s property, and remove its equipment here from without liability for reasonable and necessary damages occasioned by such entry and repossession. If Customer defaults hereunder, Customer agrees to pay Contractor for costs and expenses and reasonable Attorney fees.
ASSIGNMENT AND BENEFIT: This agreement shall be binding on the parties and their successors and assigns. This agreement may be assigned by Contractor only upon written consent of the Customer.
SPECIAL NOTE: It is mandatory in order to insure Customer Service during the winter months, that all garbage is BAGGED and SECURELY TIED (except bulky materials such as cardboard boxes) before placing into dumpster. The cold weather months that this procedure is to be observed are November 1st thru April 1st. It is highly recommended that the above bagging practice be observed all year for obvious sanitary reasons! Also, it is the Customers responsibility on collection day to have the access to the garbage dumpster clear of automobiles, snow and any other obstruction which would interfere with the dumping of the dumpster. Failure to comply with any of the above will result in the dumpster not being dumped until the following scheduled collection day, or if a special pickup is requested.

TYGARTS VALLEY SANITATION INC.

PO Box 142, Beverly, WV 26253
Phone (304)338-2003 • Fax (304)-338-2011

Business and/or individual credit application

Business Name:

Address:

City:

State:

Zip:

Phone:

Tax ID#:

Primary: Name

SS#:

Address:

City:

State:

Zip:

Home Phone:

Cell:

E-Mail:

Secondary: Name

SS#:

Address:

City:

State:

Zip:

Home Phone:

Cell:

E-Mail:

Individual Name:

Address:

City:

State:

Zip:

Phone:

SS#:

Date of Birth:

Employer Name:

Employer Address:

City:

State:

Zip:

Years Employed:

Business Phone:

Tygarts Valley Transfer Account Agreement

The information set forth in the account application is for the purpose of obtaining credit and is warranted to be true, I/we hereby authorized Tygarts Valley Transfer Inc. to investigate all references and customary credit information sources including consumer credit report in repositories regarding my/ our credit and financial responsibility for the purpose of maintaining the credit relationship.

Credit Terms: All invoices are due in full per the terms printed on the invoice or as otherwise expressly agreed. A finance charge of one and half percent (1 ½%) per month or 18% annum, or the maximum allowable by state law, may be assessed on delinquent invoices. Tygarts Valley Transfer reserves the right to change its credit terms at any time. New credit terms may be applied to existing balance on your account unless prohibited by law.

Venue, Attorney Fees, Costs: In the event of default, and if this account is turned over to an agency for collection, the undersigned agrees to pay all reasonable attorney fees, and/or costs of collection whether or not suit is filed. Venue for any action arising out of or in any way connected to this agreement, at Tygarts Valley Transfer option, shall lie in Randolph County, WV. Applicant’s signature attests to financial responsibility, ability, and willingness to pay in accordance with above terms.

Business Account Signatures:

Firm Name:

By:

Title:

By:

Title:

Individual Account Signatures:

Signature:

Print Name:

Date:

Personal Guarantee:

For valuable consideration, the receipt of which is acknowledged, including, not limited to, the extension of credit by Tygarts Valley Transfer to the above-named Company/Individual, the undersigned, as Guarantor, Individual, Jointly and severally, unconditionally guarantee(s) Tygarts Valley Transfer the full and prompt payment of all obligations which said Company/Individual may presently or hereby owe Tygarts Valley Transfer and payment when due of all sums presently or hereby owing by the Company/Individual to Tygarts Valley Transfer. Guarantor agrees to indemnity Tygarts Valley Transfer against any losses Tygarts Valley Transfer may sustain and expenses incurred in collecting or compromising any indebtedness guaranteed hereunder or in enforcing this guaranty against guarantor. This shall be a continuing Guaranty, Presentation, Demand, Protest, or notice of any kind is waived: it shall remain in full force until guarantor delivers to Tygarts Valley Transfer written notice revoking it as to indebtedness incurred subsequent to such delivery. Such delivery shall not affect any of the guarantor’s obligations hereunder with respect to indebtedness incurred prior to delivery of such notice.

The undersigned personal guarantor, recognizing that his or her individual credit history may be a necessary factor in the evaluation of this personal guarantee, hereby to and authorized the use of a consumer credit report on the undersigned, by Tygarts Valley Transfer from time to time as may be needed in the credit evaluation process.

Signature:

Print Name:

Date:

Credit Terms:

Thank you for your business, we look forward to our business relationship.

Please review the following terms of your credit account and kindly sign if you are in agreement.

Return one copy, second copy is for your records.

1. Invoices are issued at the time of tipping. A Statement is issues monthly of all unpaid invoices.
2. Full payment of the statement is expected 20 days from statement date.
3. Balances unpaid after 25 days from statement date shall incur a 1.5% service charge.
4. Credit terms are revoked for accounts with balances older than 30 days.
5. Accounts with activity averaging less than $100 per month may be asked to convert to C.O.D. account.

Accepted and Agreed

Signed:

Date: