Employment Application - Careers - Builder's Bloc - "quality construction services for 60 years"

General Application Information

Position(s) Applied For

Referral Source AdvertisementFriendRelativeWalk-InEmployment Agency Other:

Last Name

First Name

Middle Name

Address

City

State

Zip

Phone

Email Address

If employed and you are under 18, can you furnish a work permit?

YesNo

Have you filed an application here before? If yes, give date:

YesNo

Have you ever been employed here before? If yes, give date:

YesNo

Are you employed now?

YesNo

May we contact your present employer?

YesNo

Are you a U.S. citizen or can you establish that you are an authorized worker?

YesNo

On what date would you be available for work?

Are you available for work? Full-timePart-timeSpecial assignment

Are you on lay-off and subject to recall?

YesNo

Have you been convicted of a felony within the last 7 years? If yes, please explain:

YesNo

Are you a veteran of the U.S. military service? If yes, branch:

YesNo

Can you perform the essential functions involved in the job or occupation for which you applied either with or without reasonable accommodations?

YesNo

List professional, trade, business or civic activities and offices held. (Exclude those which indicate race, color, religion, sex or national origin).

Give name, address and telephone number of three references who are not related to you and are not previous employers.

Elementary School

School Name

Years Completed 45678

Diploma Degree

Describe Course of study

Describe specialized training, apprenticeship, skills & extra-curricular activities

High School

School Name

Years Completed 9101112

Diploma Degree

Describe Course of study

Describe specialized training, apprenticeship, skills & extra-curricular activities

Undergraduate College/University

School Name

Years Completed 1234

Diploma Degree

Describe Course of study

Describe specialized training, apprenticeship, skills & extra-curricular activities

Graduate Professional

School Name

Years Completed 1234

Diploma Degree

Describe Course of study

Describe specialized training, apprenticeship, skills & extra-curricular activities

Other Information

Honors Received

State any additional information you feel may be helpful to us in considering your employment.

Employment Experience

Start with your present or last job. Please describe any job-related military service or training and volunteer activities. Exclude organizations' names which indicate race, color, religion, sex or national origin.

Employer #1

Employer

Address

Date Employed From

Date Employed To

Work Performed

JobTitle

Supervisor

Reason for Leaving

Starting Hourly Rate/Salary

Final Hourly Rate/Salary

Employer #2

Employer

Address

Date Employed From

Date Employed To

Work Performed

JobTitle

Supervisor

Reason for Leaving

Starting Hourly Rate/Salary

Final Hourly Rate/Salary

Employer #3

Employer

Address

Date Employed From

Date Employed To

Work Performed

JobTitle

Supervisor

Reason for Leaving

Starting Hourly Rate/Salary

Final Hourly Rate/Salary

Employer #4

Employer

Address

Date Employed From

Date Employed To

Work Performed

JobTitle

Supervisor

Reason for Leaving

Starting Hourly Rate/Salary

Final Hourly Rate/Salary

Special Skills & Qualifications

Summarize special job-related skills and qualifications acquired from employment or other experience.

Employment Data Record

During employment, employees are treated without regard to race, color, religion, sex, national origin, age, marital or veteran status, medical condition or disability, or any other legally protected status.

We comply with government regulations, including Affirmative Action responsibilities where they apply.

The purpose of this Data Record is to comply with government record keeping, reporting, and other legal requirements. Periodic reports are made to the government on the following information. The completion of this Data Record is optional. If you choose to volunteer the requested information, please note that all Data Records are kept in a Confidential File and not a part of your Application for Employment or personnel file. Please note: YOUR COOPERATION IS VOLUNTARY. INCLUSION OR EXCLUSION OF ANY DATA WILL NOT AFFECT ANY EMPLOYMENT DECISION.

Voluntary Survey

Sunday, July 6, 2008

Government agencies at times require periodic reports on the sex, ethnicity, disability, veteran and other protected status of employees. This data is for statistical analysis with respect to the success of the Affirmative Action program. SUBMISSION OF THIS INFORMATION IS VOLUNTARY.

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Name

Address

City

State

Zip

Current Job

Birthdate

Check one: MaleFemale

Check one of the following: (ethnic origin)

White	Hispanic	American Indian/Alaskan Native
Black	Other	Asian/Pacific Islander

Check if any of the following are applicable: Vietnam Era VeteranDisabled VeteranDisabled Individual

Terms Agreement and Application Submission

The Company is an equal opportunity employer. Applicants are considered for all positions without regard to race, color, religion, sex, national origin, age, marital or veteran status, or the presence of a non-job-related medical condition or disability.

I certify that the facts contained in this application are true and complete to the best of my knowledge and understand that, if employed, falsified statements on this application shall result in immediate dismissal whenever discovered. I authorize you to obtain an investigative consumer report and/or a report from any law enforcement agency which may include both general and personal information about me. I authorize investigation of all statements contained herein and authorize the references listed above to give you any and all information concerning my previous employment and any pertinent information they may have, personal or otherwise, and release all parties from all liability for any damage that may result from furnishing same to you.

In consideration of my employment, I agree to conform to the rules and regulations of the Company and understand that my employment and compensation can be terminated, with or without cause, and with or without notice, at any time, at the option of either the Company or myself and without notice or liability for wages or salary except such earned at the date of such termination. I understand that no manager, supervisor or representative of management, other than the president (or ranking officer) has any authority to enter into an agreement for employment for any specific period of time, or to make any agreement contrary to the foregoing.

In the event that I am employed, I understand that regardless of the shift and job that I am first assigned, I may be required to accept a change of job or shift depending on my demonstrated skills after employment and the needs of the Company. I consent to take any physical or medical examinations, including blood and urine or other tests for alcohol and drugs, requested by the Company in connection with the processing of my application for employment and further agree to take any such physical or medical examinations requested by the Company during my employment if I am offered and accept a job. I understand that refusal to submit to any physical or medical examination ordered by the Company is grounds for rejection for employment or for disciplinary action up to and including immediate discharge. I further understand that any information obtained through such exams may be retained by the Company and is exclusively the Company's property. I also understand that the examinations will be performed by medical personnel, clinics or