APPLICATION FOR EMPLOYMENT

INSTRUCTIONS

1. Please read "APPLICANT NOTE."
2. Complete the entire form.
3. If more space is needed to complete any question, use comments box below.
4. This application expires 120 days from date submitted

APPLICANT NOTE

This application form is intended for use in evaluting your qualifications for employment. This is not an employment contract please answer all appropriate questions completely and accurately. False or misleading statements during the interview and on this form are grounds for terminating the application process or, if discovered after employment, terminating employment. All qualified applicants will receive consideration without discrimination because of sex, marital status, race, age, creed, national origin or the presence of disabilities. A felony conviction will not necessarily bar an applicant from employment. Affirmative action hiring may be requested by qualified applicants. Additional testing of job-related skills may be required prior to employment. After an offer of employment, and prior to reporting to work, you are required to submit to a medical review and a drug/alcohal test. Depending on company policy and the needs of the job, you will be required to complete a medical history form and may be required to be examined by a medical professional designated by the company.

*Last Name:
*First:
*Middle:
Street Address:
City:
State:
Zip:
Home Phone:
 Business Phone:
How did you learn about our company?
Are you legally authorized to work in the United States?
Yes No 		Social Security Number:
Position applied for:
 Are you employed now?
Yes No
Will you work overtime if asked?
Yes No 		Pay Expected:
Are you on layoff and subject to recall?
Yes No 		Date available for work:
Can you travel if job requires?
Yes No
Have you Worked (or) applied with us before?
If Yes give date: Month:
 Year:
Location:
 Supervisor:
Have you been convicted of a crime in the past ten years, excluding misdemeanors and summary offenses, which has not been annulled, expunged, or sealed by a court?
Yes No If yes, explain:
Note: Do not fill out any part of this section you believe to be non-job related.
List languages in which you are fluent:
Yes No If the Job requires, do you have the appropriate valid driver's license?
DL#: Type: State of issue:
Yes No Have you had any moving violations? Please describe:
Yes No Have you been given a job description or had the requirements of the explained to you?
Yes No Do you understand these requirements?
Yes No Are there any functions of this job that you think you are unable to perform? If your answer is "yes" please explain in the "comments" section on the last page.
Please list any other skills, licenses or cerificates that may be job-related or that you feel would be of value to this job or company:
EDUCATION
School
Name and
Location of School
Course of
Study
Years
Completed
Did you
Graduate
Degree/
Diploma
High School Yes No
College/University Yes No
Other Yes No
EMPLOYMENT REFERENCES

Your application will not be considered unless every question in this section is answered. Since we will
make every effort to contact previous employers, the correct telephone numbers of past employers are critical.
MOST RECENT EMPLOYER Are you currently working for this employer?
Yes No 		If yes, may we contact them:
Yes No
Company Name:
 City:
 State:
 Phone Number:
Date Employed:
From: To:		 Job Title:
 Supervisor:
Duties:
Salary $: Per Hour Per Week Per Month Reason for leaving:
SECOND MOST RECENT EMPLOYER Are you currently working for this employer?
Yes No 		If yes, may we contact them
Yes No
Company Name:
 City:
 State:
 Phone Number:
Date Employed:
From: To:		 Job Title:
 Supervisor:
Duties:
Salary $: Per Hour Per Week Per Month Reason for leaving:
THIRD MOST RECENT EMPLOYER Are you currently working for this employer?
Yes No 		If yes, may we contact them:
Yes No
Company Name:
 City:
 State:
 Phone Number:
Date Employed:
From: To:		 Job Title:
 Supervisor:
Duties:
Salary $: Per Hour Per Week Per Month Reason for leaving:
SKILLS, CRAFTS, AND WORK HISTORY ASSESSMENT

Indicate the number of years of experience you have in the following skills, crafts, or work
Skill or Craft
Years
Skill, Craft or Work Experience
Years
Asbetos Removal: Industrial Painting:
Lead Removal: Sandblasting:
Mold Remediation: Scaffolding:
Project Management: Foreman:
Project Supervision: Helper:
General Foreman: Crew Leader:
Journeyman: Turnaround:
Estimating: Plant Maintenance:
Blue Print Reading: Drafting:
Accounting: Payroll:
Cost/Job Accounting: Clerical Skills:
Personal Computer: Computer Networking:
Windows Operating System: Excel:
Word: Access:
Microsoft Project: Primavera:
Scheduling: Purchasing:
Project Safety: Engineering:
Other: Other:
Additional Comments:
References(Include only individuals familiar with your work ability. Do not include relatives)
Name: Address/Phone Number: Years Known: Relationship:
1.
2.
3.
4.
5.
CERTIFICATION AND RELEASE

I declare that the answers give by me to the questions in this application are correct to the best of my knowledge and that I understand that any misstatement, falsification, or omission of facts shall be cause for disciplinary action up to and including dismissal or rejection from employment. I authorize the company to investigate my answers to all questions in this application. I authorize any law enforcement agency or criminal history background reporting agency to furnish information in its records about me to the company or its agents. I further authorize the company to contact any of my previous employers, as well as reference sources, in order to verify the information that I have furnished regarding my qualifications and character. I hereby authorize all person(s) having knowledge thereof to provide such information to the company, and I hereby release from liability and agree to hold harmless any person that furnishes such information in good faith. I further agree that I will submit to a medical review after an offer of employment is made but prior to reporting to work. Additional testing of job related skills and for the presence of drugs in my body may be required prior to employment. I authorize the company to supply my employment records in whole or in part and in confidence to any employer, insurance agency or other party with a legal and proper interest. I hereby release the company from and liability and agree to hold harmless any employee of the company who furnised such information. I understand that I must comply with the company safety rules, including termination. I understand and agree that my employment is on an "at will" basis and that the employment relationship may be terminated by the company, or by me, at any time for any reason, with or without cause or notice. I further understand that no exceptions to this policy will be honored or recognized unless contained in a written agreement signed by a director of the company and the affected employee. Any verbal representations to the contrary are invalid and should not be relied upon.

I authorize the company to obtain an investigative consumer report on me, after an offer of employment is made, but before reporting to work, as defined by the Fair Credit Reporting Act. This report may include information pertaining to my safety and driving record. I understand that if any such inquiry is made, further information as to its nature and scope will be supplied upon written request.

I have carefully read the information on this form, I realize I had the opportunity to ask questions about it and I understand what it means.
Initials: Date: