ABOUT US ACTIVE PROJECTS PAST PROJECTS CAREERS SUB-CONTRACTORS Join the Bergeron Family of Companies Application for Employment At Bergeron, it’s our people that make us an exceptional partner for our clients. We’re always interested in qualified, highly motivated professionals who share our commitment to integrity and accountability. You can apply online by completing the form below. Step 1 of 3 Equal access to programs, services and employment is available to all persons. Those applicants requiring reasonable accommodation to the application and/or interview process should notify a representative of the Human Resources Department. Name * First Middle Last Application ID# * Date of Application * Address * Address Line 1 Address Line 2 City Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming State Zip Code Telephone * Cellular/Other Phone * Email * Position(s) Applied For * Referral Source Please check the appropriate category and list the referral source below. Walk-In Employee Advertisement Company's Website Other Internet School Job Fair Staffing Agency Government Employment Agency Other Referral Source If necessary, the best time to call you is: Date Time What number would you like us to call? Home Cellular/Other May we contact you at work? Yes No If yes, work number Best time to call Date Time If you are under 18 and it is required, can you furnish a work permit? Yes No If no, please explain: Have you submitted an application here before? Yes No If yes, give date(s) and position(s). Have you ever been employed here before? Yes No If yes, give date(s): (copy) From ___/___/___ To ___/___/___ Is this application a request for reemployment following an extended military leave of absence from this company? Yes No If yes, additional information may be requested. Are you legally eligible for employment in this country? * Yes No If yes, additional information may be requested. Date available for work: * What is your desired salary range or hourly rate of pay? (copy) * $________________________________ Per _________________________________ Type of employment desired: * Full-Time Part-Time Educational Co-Op Seasonal Temporary Will you relocate if job requires it? * Yes No Will you travel if job requires it? * Yes No If they have been explained to you, are you able to meet the attendance requirements of the position? N/A Yes No Will you work overtime if required? * Yes No If no, please explain: Are you able to perform the "essential functions" of the job for which you are applying? (with or without reasonable accommodation)? * YesNoNeed more information about the job's "essential functions" to respond This question is not designed to elicit information about an applicant's disability. Please do not provide information about the existence of a disability, particular accommodation, or whether accommodation is necessary. These issues may be addressed at a later stage to the extent permitted by law. Driver's license number required if driving may be required in the job for which you are applying: License # * State: * Have you ever been bonded? * Yes No Answering "yes" to either of the following questions does not constitute an automatic bar to employment. Factors such as date of the offense, seriousness and nature of the violation, rehabilitation, and position applied for will be taken into account. NOTE: You are not obligated to disclosed sealed or expunged records of conviction or arrest. Have you ever pleaded "guilty" or "no contest" to or been convicted of a crime? * Yes No If yes, please provide date(s) and details: Have you ever been a defendant in a civil action for an intentional tort (e.g., a civil charge for assault, battery, intentional affliction of emotional distress, false imprisonment, wrongful death, etc.)? * Yes No If yes, please provide nature of the tort and disposition of the matter (how it was resolved). Have you entered into an agreement with any former employer or other party (such as a non-competition agreement) that might, in any way, restrict your ability to work for our company? * Yes No If yes, please explain: Employment History Starting with your most recent employer, provide the following information: Most Recent Employer * Telephone # * Address * Address Line 1 Address Line 2 City Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming State Zip Code Starting Job Title/Final Job Title * Immediate supervisor and title (for most recent position held): * May we contact for reference? * Yes No Later Email address of supervisor: Why did you leave? * Summarize the type of work performed and job responsibilities: * What did you like most about your position? * What were the things you liked least about the position? * Dates employed: * From Month/Year to Month/Year Compensation (Starting) * Hourly Salary $______________ Per __________ Commission/Bonus/Other Compensation (Starting) Compensation (Final) * Hourly Salary $______________ Per __________ Commission/Bonus/Other Compensation (Final) Employer #2 #2 - Employer #2 - Telephone # #2 - Address Employer Address Line 1 Address Line 2 City Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming State Zip Code #2 - Starting Job Title/Final Job Title #2 - Immediate supervisor and title (for most recent position held): #2 - May we contact for reference? Yes No Later #2 - Email address of supervisor: #2 - Why did you leave? #2 - Summarize the type of work performed and job responsibilities: #2 - What did you like most about your position? #2 - What were the things you liked least about the position? #2 - Dates employed: From Month/Year to Month/Year #2 - Compensation (Starting) Hourly Salary $______________ Per __________ #2 - Commission/Bonus/Other Compensation (Starting) #2 - Compensation (Final) Hourly Salary $______________ Per __________ #2 - Commission/Bonus/Other Compensation (Final) Employer #3 #3 - Employer #3 - Telephone # #3 - Address Employer Address Line 1 Address Line 2 City Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming State Zip Code #3 - Starting Job Title/Final Job Title #3 - Immediate supervisor and title (for most recent position held): #3 - May we contact for reference? Yes No Later #3 - Email address of supervisor: #3 - Why did you leave? #3 - Summarize the type of work performed and job responsibilities: #4 - Summarize the type of work performed and job responsibilities: #3 - What did you like most about your position? #3 - What were the things you liked least about the position? #3 - Dates employed: From Month/Year to Month/Year #4 - Dates employed: From Month/Year to Month/Year #3 - Compensation (Starting) Hourly Salary $______________ Per __________ #3 - Commission/Bonus/Other Compensation (Starting) #3 - Compensation (Final) * Hourly Salary $______________ Per __________ #3- Commission/Bonus/Other Compensation (Final) Employer #4 #4 - Employer #4 - Telephone # #4 - Address Employer Address Line 1 Address Line 2 City Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming State Zip Code #4 - Starting Job Title/Final Job Title #4 - Immediate supervisor and title (for most recent position held): #4 - May we contact for reference? Yes No Later #4 - Email address of supervisor: #4 - Why did you leave? #4 - What did you like most about your position? #4 - What were the things you liked least about the position? #4 - Compensation (Starting) Hourly Salary $______________ Per __________ #4 - Commission/Bonus/Other Compensation (Starting) #4 - Compensation (Final) Hourly Salary $______________ Per __________ #4- Commission/Bonus/Other Compensation (Final) Explain any gaps in your employment, other than those due to personal illness, injury or disability. If not addressed previously, have you ever been fired or asked to resign from a job? Yes No If yes, please explain: Skills and Qualifications Summarize any special training, skills, licenses and/or certificates that may assist you in performing the position for which you are applying: Computer Skills Check appropriate boxes. Include software titles and years of experience. Word Processing Software Title(s) Years: Spreadsheet Spreadsheet Software Title(s) Years: Presentation Presentation Software Title(s) Years: E-Mail E-Mail Software Title(s) Years: Internet Internet Software Title(s) Years: Other Other Software #1 Years: Other Software #2 Years: Other Software #3 Years: Educational Background Starting with your most recent school attended, provide the following information: School (include City and State) Years Completed Major/Minor GPA Class Rank Diploma GED Degree Certification Other School #2 #2 - School (include City and State) #2 - Years Completed #2 - Major/Minor #2 - GPA Class Rank #2 - Diploma #2 - GED #2 - Degree #2 - Certification #2 - Other School #3 #3 - School (include City and State) #3 - Years Completed #3 - Major/Minor #3 - GPA Class Rank #3 - Diploma #3 - GED #3 - Degree #3 - Certification #3 - Other School #4 #4 - School (include City and State) #4 - Years Completed #4 - Major/Minor #4 - GPA Class Rank #4 - Diploma #4 - GED #4 - Degree #4 - Certification #4 - Other References List names and telephone numbers of three business/work references who are not related to you and are notprevious supervisors. If not applicable, list three school or personal references who are not related to you. #1 Reference - Name * #1 Reference - Title * #1 Reference - # of Years Known * #1 Reference - Relationship to You * #1 - Email * #1 - Phone * Reference #2 #2 Reference - Name * #2 Reference - Title * #2 Reference - # of Years Known * #2 Reference - Relationship to You * #2 - Email * #2 - Phone * Reference #3 #3 Reference - Name * #3 Reference - Title * #3 Reference - # of Years Known * #3 Reference - Relationship to You * #3 - Email * #3 - Phone * Social Security Number We will use this information only for employment purposes and make reasonable efforts to safeguard your privacy. Social Security Number * ______-____-_______ Related Information To what job-related organizations (professional, trade, etc.) do you belong? Exclude memberships that would reveal race, color, religion, sex, national origin, genetic information, citizenship, age, mental or physical disabilities, veteran/reserve national guard or any other similarly protected status. #1 - Organization #1 - Offices Held #2 - Organization #2 - Offices Held #3 - Organization #3 - Offices Held #4 - Organization #4 - Offices Held List special accomplishments, publications, awards, etc. Exclude information that would reveal race, color, religion, sex, national origin, genetic information, citizenship, age, mental or physical disabilities, veteran/ reserve national guard or any other similarly protected status. In your current or a prior job, have you ever written instructions or directions to be followed by employees or customers? * Yes No Not Applicable If yes, please explain: Is there any other job-related information you want us to know about you? Applicant Statement I certify that all information I have provided in order to apply for and secure work with this employer is true, complete and correct. I expressly authorize, without reservation, the employer, its representatives, employees or agents to contact and obtain information from all references (personal and professional),employers, public agencies, licensing authorities and educational inst itutions and to otherwise verify the accuracy of all information provided by me in this application, resume or job interview. I hereby waive any and all rights and claims I may have regarding the employer, its agents. employees or representatives, for seeking, gathering and using truthful and non-defamatory information, in a lawful manner, in the employment process and all other persons, corporations or organizations for furnishing such information about me. I understand that this employer does not unlawfully discriminate in employment and noquestion on this application is used for the purpose of limiting or eliminating any applicant from consideration for employment on any basis prohibited by applicable local, state or federal law. I understand that this application remains current for only 30 days. At the conclusion of that time, if I have not heard from the employer and still wish to be considered for employment, it will be necessary for me to reapply and fill out a new application. If I am hired, I understand that I am free to resign at any time, with or without cause and with or without prior notice, and the employer reserves the same right to terminate my employment at any time, with or without cause and with or without prior notice, except as may be required by law. This application does not constitute an agreement or contract for employment for any specified period or definite duration. I understand that no supervisor or representative of the employer is authorized to make any assurances to the contrary and that no implied oral or written agreements contrary to the foregoing express language are valid unless they are in writing and signed by the employer's president. I understand that if I am hired, my employment will be subject to a probationary period, which ordinarily will not exceed 90 days from the date I am hired. IO am discharged at anytime during the probationary period for unsatisfactory performance, I understand that this employer will not be charged for any unemployment benefits that may be paid to me for work I performed during the probationary period. I also understand that if I am hired, I will be required to provide proof of identity and legal authorization to work in the United States and that federal immigration laws require me to complete an 1-9 Form in this regard. This Company does not tolerate unlawful discrimination in its employment practices. No question on this application is used for the purpose of limiting or excluding an applicant from consideration for employment on the basis of his or her sex, race, color, religion, national origin, genetic information, citizenship, age, disability, or any other protected status un der applicable federal, state, or local law. This Company likewise does not tolerate harassment based on sex, race, color, religion, national origin, genetic information, citizenship, age, disability, or any other protected status. Examples of prohibited harassment include, but are not limited to, unwelcome physical contact, offensive gestures, unwelcome comments, jokes, epithets, threats, insults, name-calling, negative stereotyping, possession or display of derogatory pictures or other graphic materials, and any other words or conduct that demean, stigmatize, intimidate, or single out a person because of his/her membership in a protected category. Harassment of our employees is strictly prohibited, whether it is committed by a manager, coworker, subordinate, or non-employee (such as a vendor or customer). The Company takes all complaints of harassment seriously and all complaints will be investigated promptly and thoroughly. I understand that any information provided by me that is found to be false, incomplete or misrepresented in any respect, will be suffi cient cause to (i} eliminate me from further consideration for employment, or (ii} may result in my immediate discharge from the employer's service, whenever it is discovered. DO NOT SIGN UNTIL YOU HAVE READ THE ABOVE APPLICANT STATEMENT. I certify that I have read, fully understand and accept all terms of the foregoing Applicant Statement. Signature of Applicant * Clear Signature Date * Next Section - New Hire EEO-1 Data Sheet Reaffirmation of Affirmative Action Policy Statement CLICK TO DOWNLOAD Available Jobs Jobs at Bergeron Land Development, Inc. Job Openings: We currently do not have any job openings. Powered by ZipRecruiter 19612 SW 69th Place · Fort Lauderdale, FL 33332 · 954.680.6100 / fax 954.680.0666 SUB-CONTRACTORS Website Designed and Developed by: Electrum Branding © 2021 Bergeron Land Development, Inc.. All rights reserved