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 company. 1Start2Employment3Experience4References5Signature Position applied for* Name* First Middle Last Address* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code TelephoneCellEmail* How did you hear about us?*Are you legally eligible for employment in this country?* Yes No Date available for work* MM slash DD slash YYYY What is your desired salary range?* Type of employment desired* Full-Time Part-Time Temporary Seasonal Starting with your most recent employer, please provide the following information.Employer 1Employer PhoneAddress Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Dates Employed Ex: Month/Year to Month/YearStarting Job Title Starting Wage Final Job Title Final Wage Immediate Supervisor and Title Why did you leave?Summarize the type of work performed and job responsibilitiesWhat did you like most about your position?What were the things you like least about the position?May we contact for reference? Yes No Employer 2Employer PhoneAddress Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Dates Employed Ex: Month/Year to Month/YearStarting Job Title Starting Wage Final Job Title Final Wage Immediate Supervisor and Title Why did you leave?Summarize the type of work performed and job responsibilitiesWhat did you like most about your position?What were the things you like least about the position?May we contact for reference? Yes No ExperiencePlease check the column that closest describes your experience.Supervision* No Experience Some Experience Much Experience Survey/stakeout/building layout* No Experience Some Experience Much Experience Equipment operation* No Experience Some Experience Much Experience Welding work* No Experience Some Experience Much Experience Rough carpentry* No Experience Some Experience Much Experience Layout walls* No Experience Some Experience Much Experience Metal roofing* No Experience Some Experience Much Experience Metal soffit/fascia* No Experience Some Experience Much Experience Metal siding* No Experience Some Experience Much Experience Hang metal or wood doors* No Experience Some Experience Much Experience Mount windows* No Experience Some Experience Much Experience Steel building erection* No Experience Some Experience Much Experience Pole building erection* No Experience Some Experience Much Experience Commercial construction* No Experience Some Experience Much Experience Please list any additional skills or comments to the answers given above. ReferencesList names and telephone numbers of three business/work references who are not related to you and ar not previous supervisors. If not applicable, list three schools or personal references who are not related. to you. Reference 1Name* First Last Title* Relationship to You* Telephone Number*Number of Years Known* Reference 2Name* First Last Title* Relationship to You* Telephone Number*Number of Years Known* Reference 3Name* First Last Title* Relationship to You* Telephone Number*Number of Years Known* 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 institutions 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 no question on this application is used for the purpose of limiting or eliminating any applicant from consideration for empl oyment on any basis prohibited by applicable local, state or federal law. I understand that this application remains current for 90 days. At the conclusion of that time, if I have not heard from the employer and still wish to be considered for employment, 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 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 of America and that federal immigration laws require me to complete an I-9 Form in this regard. I understand that any information provided by me that is found to be false, incomplete or misrepresented in any respect, will be sufficient cause to (1) eliminate me from further consideration for employment, or (2) 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* Date* MM slash DD slash YYYY
