EMPLOYMENT APPLICATION FORM APPLICATION FOR EMPLOYMENT Position(s) Applying for * Type work you are available for: * Full-Time Part-Time Shift Work Temporary Are you at least 18 years old? * Yes No Date of Application * MM DD YYYY Full Name * Please include Middle name First Name Last Name Address * Address 1 Address 2 City State/Province Zip/Postal Code Country Main Phone * (###) ### #### Alternate Phone (###) ### #### Email * EMPLOYMENT EXPERIENCE Please list the names of your present or previous employers in chronological order with present or most recent employer listed first. Be sure to account for all periods of time. If self-employed, give firm name and supply business references. Add additional page if necessary. Name of Employer * Supervisor * May we contact? * Yes No Address * Phone * (###) ### #### Dates Employed * Include Month/Year Job Title & Duties * Reason for Leaving * EMPLOYMENT EXPERIENCE Name of Employer Supervisor May we contact? Yes No Address Phone (###) ### #### Dates Employed Include Month/Year Job Titles & Duties Reason for Leaving EMPLOYMENT EXPERIENCE Name of Employer Supervisor May we contact? Yes No Phone (###) ### #### Dates Employed Include Month/Year Job Title & Duties Reason for Leaving EMPLOYMENT EXPERIENCE Have you ever been involuntarily terminated or asked to resign from any job? * Yes No If yes, please explain: Please explain any gaps in your employment history: Please list any other experience, job related skills, additional languages, or other qualifications that you believe should be considered in evaluating your qualifications for employment: EDUCATION BACKGROUND HIGH SCHOOL School Name Years Completed Diploma Yes No Specialized Training, Skills, or Extra Curricular Activities COLLEGE/UNIVERSITY School Name Years Completed Degree Yes No Area of Study/Major Specialized Training, Skills, or Extra Curricular Activities GRADUATE/PROFESSIONAL SCHOOL School Name Years Completed Area of Major/Study Degree Yes No Specialized Training, Skills, or Extra Curricular Activities TRADE SCHOOL School Name Years Completed Degree Yes No Area of Study/Major Specialized Training, Skills, or Extra Curricular Activities EMPLOYMENT EXPERIENCE Other education information you'd like to include: BUSINESS & PROFESSIONAL REFERENCES Please list three professional references of individuals who are not related to you. Name & Title * Relationship * Phone Number or Email * Name & Title * Relationship * Phone Number or Email * Name & Title * Relationship * Phone Number or Email * PERSONAL REFERENCES Please list three people who know you well. Name & Title * Relationship * Phone Number or Email * Name & Title * Relationship * Phone Number or Email * Name & Title * Relationship * Phone Number or Email * GENERAL INFORMATION Have you ever used another name? If Yes, please specify: On what date are you available to work? * MM DD YYYY If hired, would you be willing to work a modified work schedule? * Yes No DAYS/HOURS AVAILABLE TO WORK Monday * Tuesday * Wednesday * Thursday * Friday * Saturday * Sunday * Hourly Rate Requested * $ If hired, would you have a reliable means of transportation to and from work? * Yes No Can you travel if the position requires it? * Yes No If hired, are you able to present evidence of your identity and legal right to work in this country? * Yes No Are you able to perform the essential job functions of the job for which you are applying? * Yes No Have you ever been convicted of a misdemeanor or felony? * Yes No If Yes, please give a date/explanation: If hired, would you be willing to undergo a background check? * Yes No Do you have a satisfactory driving record? (2 points or less) * Yes No Are you able you lift a minimum of 70 pounds? * Yes No Are you comfortable working on ladders/lifts? * Yes No APPLICATION STATEMENT & AGREEMENT Please read and initial each paragraph below. If there is anything that you do not understand, please ask. I hereby authorize the Company to thoroughly investigate my references, work record, education and other matters related to my suitability for employment and, further, authorize the prior employers and references I have listed to disclose to the Company any and all letters, reports and other information related to my work records, without giving me prior notice of such disclosure. In addition, I hereby release the Company, my former employers and all other persons, corporations, partnerships and associations from any and all claims, demands or liabilities arising out of or in any way related to such investigation or disclosure. * (Checked box indicates acknowledgement) In the event of my employment with the Company, I understand that I am required to comply with all rules and regulations of the Company. * (Checked box indicates acknowledgement) If hired, I understand and agree that my employment with the Company is at-will, and that neither I, nor the Company is required to continue the employment relationship for any specific term. I further understand that the Company or I may terminate the employment relationship at any time, with or without cause, and with or without notice. I understand that the at-will status of my employment cannot be amended, modified, or altered in any way by any oral modifications. * (Checked box indicates acknowledgement) I understand that safety of employees is extremely important to the Company and that the Company is committed to ensuring a safe working environment. I understand that I, and every employee, have a responsibility to prevent accidents and injuries by observing all safety procedures and guidelines and following the directions of my site supervisor. I understand and agree to comply with federal, state, and local regulations related to on-the-job safety and health. * (Checked box indicates acknowledgement) I hereby certify that the answers given by me are true and correct to the best of my knowledge. I further certify that I, the undersigned applicant, have personally completed this application. I understand that any omission or misstatement of material fact on this application or on any document used to secure employment shall be grounds for rejection of this application or for immediate discharge if I am employed, regardless of the time elapsed before discovery. * (Checked box indicates acknowledgement) I understand that if I am selected for hire, it will be necessary for me to provide satisfactory evidence of my identity and legal authority to work in the United States, and that federal immigration laws require me to complete an I-9 Form in this regard. * (Checked box indicates acknowledgement) I understand that if any term, provision, or portion of this Agreement is declared void or unenforceable, it shall be severed and the remainder of this Agreement shall be enforceable. * (Checked box indicates acknowledgement) MY SIGNATURE BELOW ATTESTS TO THE FACT THAT I HAVE READ, UNDERSTAND, AND AGREE TO ALL OF THE ABOVE TERMS. Signature * Name * Date * MM DD YYYY Legal Disclaimer: This document is intended for informational purposes only, and does not constitute legal information or advice. This information and all HR Support Center materials are provided in consultation with federal and state statutes and do not encompass other regulations that may exist, such as local ordinances. Transmission of documents or information through the HR Support Center does not create an attorney-client relationship. If you are seeking legal advice, you are encouraged to consult an attorney. CONTACT US California General Contractor Lic #1022524 | Arizona General Contractor Lic #319985 © 2021 CREATIVE CONSTRUCTION