| PERSONAL INFORMATION |
| Last Name: First Name:
Middle Initial:
SSN:
|
| Drivers License Number:
State of Issue:
Email:
|
| Present Address (street, city, state, zip):
|
| Permanent Address (street, city, state, zip):
|
| Are you 18 Years or Older:
Yes
No
Phone: Apt. No:
|
| In case of emergency notify (name, address, phone):
|
| Are you prevented from lawfully becoming employed in this
country because of VISA or immigration status?
Yes
No |
| EMPLOYMENT DESIRED |
| Position:
Date you can start:
Salary Desired: |
| Are you employed now?Yes
No
If so may we inquire of your present employer?
Yes
No |
| If no, explain:
|
| What prompted you to apply at Crouch Building Associates?
|
| Are you willing to travel?
Yes
No |
| What makes you a team player?
|
| Ever applied to this company before?
Yes
No When? |
| Ever worked for this company before?Yes
No When? |
| Reason for leaving?
|
| Name of last supervisor at this company:
|
| Who referred you to this company? (employment agency,
newspaper ad, etc) |
| Previous Work Experience: (check all that applies) |
| Labor
Carp.
Mechanical
Carp. Iron
Worker
Concrete
Finisher
Backhoe
Operator |
|
Estimating
Supervisor
Project
Manger
CDL License
Cement Mason |
|
Surveyor
Other
(explain:
) |
| |
| List number of years Experience in:
Commercial Construction
|
| Supervisor of 3 or more workers:
Managing/Supervising Sub-Contractors:
|
| EDUCATION |
| Grade School: Name
No. of Years
Graduate?
Yes
No |
| High School: Name
No. of Years Graduate?
Yes
No |
| College: Name
No. of Years Graduate?
Yes
No |
| Trade, Business, or Correspondence School: Name
No. of Years
Graduate?
Yes
No |
| GENERAL |
| Subjects of special study or research work:
|
| Special Training:
|
| Special Skills:
|
| List of Equipment that you can operate proficiently:
|
| Forklift Training Card: CPL
CLASS
First Aid
CPR (check
if applicable) |
| FORMER EMPLOYERS
(list below last three employers, starting with the last one first) |
| Name and Address of Present or Last Employer:
|
| Starting date (Month/Year):
Leaving Date (Month/Year):
|
| Weekly Starting Salary:
Weekly Final Salary:
|
| Job Title:
May We Contact Your Supervisor:
Yes
No |
| Name and Title of Supervisor:
|
| Description of Work:
Reason for
Leaving:
|
| |
| Name and Address of Present or Last Employer:
|
| Starting date (Month/Year):
Leaving Date (Month/Year):
|
| Weekly Starting Salary:
Weekly Final Salary:
|
| Job Title:
May We Contact Your Supervisor:
Yes
No |
| Name and Title of Supervisor:
|
| Description of Work:
Reason for
Leaving:
|
| |
| Name and Address of Present or Last Employer:
|
| Starting date (Month/Year):
Leaving Date (Month/Year):
|
| Weekly Starting Salary:
Weekly Final Salary:
|
| Job Title:
May We Contact Your Supervisor:
Yes
No |
| Name and Title of Supervisor:
|
| Description of Work:
Reason for
Leaving:
|
| References
(give 3 names of people not related to you whom you have
worked with for at
least a year) |
| Name:
Address: Business:
|
| Years Acquainted:
|
| |
| Name:
Address: Business:
|
| Years Acquainted:
|
| |
| Name:
Address: Business:
|
| Years Acquainted:
|
| Service Record |
| Branch of Service:
Discharge Date Rank:
|
| Present Membership in National Guard or Reserves:
Yes
No Date
Obligation Ends: |
| Special
Questions |
| Height:
Are you a US Citizen:
Yes
No |
| Are you able to perform each of the following job
functions with or without accommodation: |
| Job Function 1: Lift and Carry 75 lbs for 100 Feet:
Yes
No |
| If you can perform this function with an accommodation,
explain how you would perform the tasks, and with what accommodation:
|
| Job Function 2: Climb Ladder and Work at 30 FT. Above
the Ground:
Yes
No |
| If you can perform this function with an accommodation,
explain how you would perform the tasks, and with what accommodation:
|
| Were You Ever Seriously Injured:
Yes
No |
| Give Details:
|
| Are you bilingual?
Yes
No
If yes, language:
|
| Proficiency: Speak Fluently?
Yes
No
Write Fluently?
Yes
No |
| |
| Will you abide by the safety rules of this company?
Yes
No |
| |
| I understand and agree that I may be required to take a
physical examination, drug test, and/or a lie detector test as a condition of hiring or
continued employment. I agree to consent to take such test(s) at such time
as designated by the Company and to release the Company, its directors,
officers, agents or employees from any claim arising in condition with the
use of such test(s):
Yes
No |
| |
| I have been advised that lie detector tests, as a
condition of hiring or continued employment, are prohibited by law. You
will not be denied employment solely because of a conviction record,
unless the offense is related to the job for which you have applied:
Yes
No |
| |
| SUPPLEMENTAL
INFORMATION - THIS INFORMATION IS MAINTAINED CONFIDENTIALLY |
| Do you have any misdemeanor or felony convictions?
Yes
No |
| A "yes" response does NOT disqualify you from employment;
however, it does require a complete explanation including dates, nature of
offense and disposition. |
| Explain Fully:
|
| |
- Do you have any convictions of traffic violations or accidents,
including DUI where the fine was more
- than $100 over the last three years?
Yes
No
|
| A "yes" response does NOT disqualify you from employment;
however, it does require a complete explanation including dates, nature of
offense and disposition. |
| Explain Fully:
|
| |
| have you ever been denied a license, permit or privilege
to operate a motor vehicle or had a license, permit or privilege revoked
or suspended?
Yes
No |
| A "yes" response does NOT disqualify you from employment;
however, it does require a complete explanation including dates, nature of
offense and disposition. |
| Explain Fully:
|
| |
| Are you now being investigated for any alleged misconduct
or other alleged grounds for discipline by any licensing, certification,
or other regulatory body or by your current or any previous employer? If
you answer "Yes" you must provide the name, address, and telephone number
of the employer or licensing body and a statement of the accusations
against you?
Yes
No |
| Explain Fully:
|
| |
| I understand that should I fail to list all convictions,
my application will not receive further consideration and I will not be
considered for employment. I further understand that if I obtain
employment with Crouch Building Associates and information is received
regarding a conviction, which should have been listed on this application,
I will be subject to disqualification and/or dismissal from employment.
Yes
No |
| |
| Have you ever been dismissed (fired) from any job, or
resigned at the request of your employer?
Yes
No
If you answer "YES" you must provide the date of termination of
employment, the name, address and telephone number of the employer(s) and
a statement of the alleged reasons for the termination. A "YES" answer is
not disqualifying and will be considered individually, but should be
explained fully.
|
| AUTHORIZATION |
| I certify that all the information
submitted by me on this application is true and complete, and I understand
that if any false information, omissions, or misrepresentations are
discovered, my application my be rejected and, if I am employed, my
employment may be terminated at any time. In consideration of my
employment, I agree to conform to the company's rules and regulations, and
I agree that my employment and compensation can be germinated, with or
without cause, and with or without notice, at any time, at either my or
the company's option. I also understand and agree that the terms and
condition of my employment may be changed, with or without cause and with
or without notice, at any time by the company. I understand that no
company representative, other than its president, and then only when in
writing and signed by the president, has any authority to enter into any
agreement for employment for any specific period of time, or to make an
agreement contrary to the foregoing. |
| Electronic Name/Signature:
Date: |