EMPLOYEE SECTION
NAME
*
DATE
*
ADDRESS
*
TIME AT THIS ADDRESS - YEARS
*
:
MONTHS
*
:
PHONE
*
(example: xxx-xxx-xxxx)
EMAIL ADDRESS
*
SOCIAL SECURITY NUMBER
*
(example: xxx-xx-xxxx)
DATE of BIRTH
*
Have you spoken to a Gen. Foreman about employment?
Yes
No
If so, what is his/her name?
What state will you be working in?
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
Dist 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
ANSWER ALL QUESTIONS BELOW
YES
NO
Are you 18 years of age or older?
*
Have you ever filed a job application with us before?
*
Are you able to perform the duties of the job for which you are applying with or without reasonable accommodation?
*
Are you currently employed?
*
May we contact your present employer?
*
Are you legally eligible to work in the United States?
*
Proof of citizenship or immigration status WILL BE required upon employment.
This job may reqire that you travel. If you are employed with us are you willing to travel?
*
(Failure to travel for the job may result in your being inelegible for employment since we provide emergency storm work for most of or clients).
Due to the nature of our business, during your employment period, if a contract ends, you may be asked to relocate to another area where there is work available; failure to transfer might result in termination of employment.
If hired, do you agree that this will be a condition of employment?
*
Failure to meet weekly production can result in disciplinary action leading to termination; do you understand?
*
Do you have a CDL Driver's License?
No
Class A
Class B
On what date would you be available for work?
*
What type of job are you available for?
*
Full time
Part time
Shift Work
Temporary
CRIMINAL HISTORY
Have you ever been convicted, pled guilty or no contest to a felony and/or misdemeanor offense?
*
YES
NO
List each and every conviction, guilty plea, or plea of no contest:
City/State of Offense:
Charge:
Date:
Results:
Explain action against you:
City/State of Offense:
Charge:
Date:
Results:
Explain action against you:
If you need more space for additional listings, use this button.
The nature of the Company's business requires our employees to be in close proximity to the general public. Accordingly, for the safety of our customers, the general public, and oour employees, it is the Company's policy not to hire (and to terminate upon notice of such) any person who has been convicted of sexual predator or sexual offender laws or who are required to reqister as a sexual predator or sexual offender. Consequently, the Company also reserves the right not to hire, or to terminate upon notice of such, any employee who has been previously convicted of a felony of any type.
EMPLOYMENT RECORDS - YOU MUST ACCOUNT FOR ALL EMPLOYMENT
IN THE PAST THREE YEARS
Start with your present or last job. Include any job related military service assignments.
CURRENT OR MOST RECENT EMPLOYER
Name of Employer
*
Phone
*
(example: xxx-xxx-xxxx)
Address
*
Date Employed - From
*
:
To
*
:
Beginning Hourly Rate/Salary
*
Ending Hourly Rate/Salary
*
Positions/Duties
*
Supervisor
*
Eligible for Rehire?
*
Reason for leaving
*
NEXT PREVIOUS EMPLOYER
Name of Employer
Phone
(example: xxx-xxx-xxxx)
Address
Date Employed - From:
To:
Beginning Hourly Rate/Salary
Ending Hourly Rate/Salary
Positions/Duties
Supervisor
Eligible for Rehire?
Reason for leaving
NEXT PREVIOUS EMPLOYER
Name of Employer
Phone
(example: xxx-xxx-xxxx)
Address
Date Employed - From:
To:
Beginning Hourly Rate/Salary
Ending Hourly Rate/Salary
Positions/Duties
Supervisor
Eligible for Rehire?
Reason for leaving
If you need space for another employer, click this button.
Use this space to give us other information about your personal skills or qualities, work style, interpersonal ability or communication skills which would further qualify you for this job.
REFERENCES
Name only those persons who are familiar with your work capabilities.
Do not list relatives.
Name
*
Phone
*
(example: xxx-xxx-xxxx)
Address
*
Position
*
Years Known
*
Name
*
Phone
*
(example: xxx-xxx-xxxx)
Address
*
Position
*
Years Known
*
Name
*
Phone
*
(example: xxx-xxx-xxxx)
Address
*
Position
*
Years Known
*
LIST ALL PREVIOUS ADDRESSES FOR THE LAST SEVEN (7) YEARS
Address, city, state, zip code and county if know.
(1)
Time at this address - years:
months:
(2)
Time at this address - years:
months:
(3)
Time at this address - years:
months:
(4)
Time at this address - years:
months:
(5)
Time at this address - years:
months:
(6)
Time at this address - years:
months:
(7)
Time at this address - years:
months:
(8)
Time at this address - years:
months:
CONSUMER DISCLOSURE AND AUTHORIZATION FORM
The company and/or its clients (collectively the "Company") may request, for lawful employment purposes, background information about you from a consumer reporting agency in connection with your employment or application for employment(including independent contractor assigments, as applicable). This background information may be optained in the form of consumer reports and/or investigative consumer reports (commonly known as "background reports"). These background reports may be obtained at any time after receipt of your authorization and, if you are hired or engaged by the Company, throughout your emloyment with the Company or your contract period.
The types of information that may be obtained include, but are not limited to: social security number verifications; address history; credit reports and history; criminal records and history; public court records; driving records; accident history; worker's compensation claims; bankruptcy fillings; educational history verifications (e.g., dates of attendance, degrees obtained); employment history verifications (e.g., dates of employment, salary information, reasons for termination, etc.); personal and professional references checks; professional licensing and certification checks; drug/alcohol testing results, and drug/alcohol history in violation of law and/or company policy; and other information bearing on your character, general reputation, personal characteristics, mode of living and credit standing.
This information may be obtained from private and public record sources, including, as appropriate: government agencies and courhouses; educational institutions; former employers; personal interviews with sources such as neighors, friends and associates; and other information sources. If the Company should obtain information bearing on your credit worthiness, credit standing or credit capacity for reasons other than as required by law, then the Company will use such credit information to evaluate whether you should be offered a position or be permitted to retain your position. You may request more information about the nature and scope of any investigative consumer reports by contacting the Company. A summery of your rights under the Fair Credit Reporting Act is also being provided to you.
AUTHORIZATION OF BACKGROUND INVESTIGATION
I have carefully read and understand this Disclosure and Authorization form and the attached summary of rights under the Fair Credit Reporting Act. By my signature below, I consent to preparation of background reports by a consumer reporting agency, hired by the Company or it's clients (the "Company"), and to the release of such background reports to the Company and any of their designated representatives and agents, for the purpose of assisting the Company in making a determination as to my eligibility for employment (including independent contractor assignments, as applicable), promotion, retention or for other laswul employment purposes. I understand that if the Company hires me or contracts for my services, my consent will apply, and that Company may obtain background reports, throughout my employment or contract period.
I understand that information contained in my employment or contractor application, or otherwise disclosed by me before or during my employment or contact assignment, if any, may be used for the purpose of obtaining and evaluating background reports on me. I also understand that nothing herein shall be construed as an offer of employment or contract for services.
I hereby authorize law enforcement egencies, learning institutions (including public and private schools and universities), information service bureaus, credit bureaus, record/data repositories, courts (federal, state and local), motor vehicle records agencies, my past or present employers, the military, and other individuals and sources to furnish any and all information on me that is rquested by the sonsumer reporting agency.
I understand that a Company client may conduct background investigations to confirm by eligibility to work on its premises during my employment with the Company. Accordingly, I herby authorize the Company to provide its clients with information that can be used to conduct a background investigation, such as my birth date, social security number, country of citizenship, and any other information that I have provided to the Company that might be used in conduction a background investigation of me. I hereby release and hold harmless the Company for the disclosure of this information to its clients.
By my signature below, I also certify the information I provided on and in connection with this form is true, accurate and complete. I agree that this form in original, faxed, photocopied or electronic (including electronically signed)form; will be valied for any background reports that may be requested by or on behalf of the Company and/or it's clients.
Enter your name
*
Electronic Signature
*
As your electronic signature, enter your mother's maiden name.
Date
*
mm/dd/yyyy
APPLICANT'S ACKNOWLEDGMENT
I certify that all informaion provided in this Employmnet Application is true, correct, and complete. I also certify that I have accounted correctly for my work experience, education, training, and all other background information. I understand that not providing information is the same thing as not giving true information. I authorize investigation of all statements contained in this application for employment as may be necessary in arriving at an employment decision.
This application for employment shall be considered active for a period of time not to exceed 180 days. Any applicant wishing to be considered for employment beyond this time period should inquire as to whether or not applications are accepted at that time. If employed, during the course of employment there will be random drug screens, post accident and/or reasonalbe suspicious testing. If I fail or refuse either one, it may result in termination of employment.
I understand that if the Company offers me employment that I will be required to successfully complete a pre-employment physical examination conducted by a company-authorized physician and that I will be requred to successfully complete a pre-employment drug screening after a job offer of employment has been made.
I understand that if I misrepresented or omitted any fact(s) from this Employment Application that I may be disqualified from employment or terminated from employment. I authorize the Company and/or its agents, including consumer and/or credit reporting bureaus, to verify any information contained in this Employment Application
I further understand and agree that employment with the Company will be "at will." This is, either I or the Company may end the employment relationship at any time for any reason or for no reason. Also, I understand that no representative if the Company has the authority to enter into any agreement with me for employment for any specific period of time.
Electronic Signature
*
As an electronic signature, enter your mother's maiden name.
Enter your full name
*
Date
*
