Employment Application Form Personal InformationName* First Last Home PhoneCell PhoneEmail* Preferred method of contact* Home Phone Cell Phone Email Address* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Position InformationYour work history and any employment gaps: MUST be completed even when accompanied by a résumé. List most recent or current jobs first. You must include any gaps in employment, with a full explanation and dates for the gap. You must also provide a complete work history for a minimum of 15 years.JOB 1 (Most Recent)Employer Information*EmployerJob TitlePhoneEmployer's Address*CityStateZipDates Employed*Started (month/year)Ended (month/year)Hourly Rate, Weekly Salary or other Weekly Earnings*StartingEndingResigned or Terminated*State reasonSupervisor's NameSummary of Work Performed & Job Responsibilities*JOB 2Employer InformationEmployerJob TitlePhoneEmployer's AddressCityStateZipDates EmployedStarted (month/year)Ended (month/year)Hourly Rate, Weekly Salary or other Weekly EarningsStartingEndingResigned or TerminatedState reasonSupervisor's NameSummary of Work Performed & Job ResponsibilitiesJOB 3Employer InformationEmployerJob TitlePhoneEmployer's AddressCityStateZipDates EmployedStarted (month/year)Ended (month/year)Hourly Rate, Weekly Salary or other Weekly EarningsStartingEndingResigned or TerminatedState reasonSupervisor's NameSummary of Work Performed & Job ResponsibilitiesJOB 4Employer InformationEmployerJob TitlePhoneEmployer's AddressCityStateZipDates EmployedStarted (month/year)Ended (month/year)Hourly Rate, Weekly Salary or other Weekly EarningsStartingEndingResigned or TerminatedState reasonSupervisor's NameSummary of Work Performed & Job ResponsibilitiesJOB 5Employer InformationEmployerJob TitlePhoneEmployer's AddressCityStateZipDates EmployedStarted (month/year)Ended (month/year)Hourly Rate, Weekly Salary or other Weekly EarningsStartingEndingResigned or TerminatedState reasonSupervisor's NameSummary of Work Performed & Job ResponsibilitiesEducationHigh School*Name/City & StateCourse of StudyNumber of Years CompletedDegree/Diploma ConferredCollegeName/City & StateCourse of StudyNumber of Years CompletedDegree/Diploma ConferredGraduate StudyName/City & StateCourse of StudyNumber of Years CompletedDegree/Diploma ConferredOther EducationName/City & StateCourse of StudyNumber of Years CompletedDegree/Diploma ConferredTell Us About YourselfYou MUST answer EVERY question on this application. If a question does not apply, put “N/A”.What position are you applying for?*What is your salary expectation?*When can you start?*How were you refered to us?*If you were referred by an employee please tell us whom it wasHave you completed applications here before? Yes No What date and location did you fill out an application before?Have you been employed here before?* Yes No What date, position, and location were you employed?Are you available to work:* Full-time Part-Time Weekends Nights Temp Are you willing to work overtime?* Yes No List any days/times you are not able to workDo you have steady transportation to work?* Yes No If necessary, can you provide proof that you are over any minimum work age requirement?* Yes No Can you travel, if required?* Yes No What percentage of the time?Are you on a layoff and subject to recall?* Yes No May we contact your current employer?* Yes No How much time have you lost from work during the past 12 months?*Are you now, or do you expect to be, engaged in any other business or employment while working here?* Yes No Please explainAre you presently an officer, employee, or employer of another business in our industry or with whom we compete?* Yes No Please explainHave you ever been refused a bond?* Yes No Are you legally eligible to work in the United States?* Yes No Why do you wish to make an employment change?*What three things are most important to you in a job?123What three adjectives best describe you?123What type of work do you most enjoy?Why do you want to work here?*What motivates you the most?How do you measure your own success?Tell us about your Special Skills and QualificationsList any professional, trade, business, or civic activities that would relate to working here*List all languages that you fluently speak, read, and or write.*Tell Us About Your Driving RecordNecessary for positions that may require use of a personal or company vehicle for work.Do you hold a valid Driver’s License?* Yes No What state is your driver's license issue?Have you been convicted of any moving violation(s) in the past 3 years ?* Yes No If yes, give date(s) and explanation of eachDateExplantion Click the plus sign (+) to add more rowsTell Us About Your PastAnswering “Yes” to any of these questions is not an automatic bar to employment.Have you ever been disciplined or terminated from any job for an act of violence, harassment, discrimination, ethical breach or theft?* Yes No If yes, explain the circumstances, employer, and dateHave you ever been a defendant in a civil action for an intentional tort?* Yes No (e.g. assault, false imprisonment, infliction of emotional distress, torturous interfere nce with a business relationship, defamation, invasion of privacy, fraud and misrepresentation, abuse of process and malicious prosecution or others)If yes, provide an explanation of the nature of the intentional tort, the date of the action, the location, an the disposition or outcomeDo you currently have any criminal charges pending against you?* Yes No If yes, describe the details of the charge(s), the date(s) of the offence(s), your age at the time of the offense(s), and the current status of the charge(s)Are you currently wanted by any law enforcement agency?* Yes No If yes, by what agency and for what act?Tell Us About Any RecordsHave you ever been convicted of; received a sentence for; pled nolo contendere (no contest) to; been placed on probation, fined, or entered a pretrial intervention program for; or had adjudication withheld by any judicial or quasi - judicial bod y for a crime, other than a minor traffic violation?* Yes No Any criminal record not disclose by you may be considered falsification of the application, which may result in revocation of your employment offer or termination of your employment. Also, in accordance with any state or federal regulation, you may be required to provide copies of any criminal records. Answering “yes” to this question is not an automatic bar to employmentDescribe the details of the conviction or other disposition of the charge, the date of the offence (month and year), you r age at the time of the offence, and your rehabilitation since the conviction and /or disposition of the offenceMiltary ServiceBranch of ServiceRank at discharge, if applicable List duties and special training and/ or skills:*ReferencesList two personal references other than relatives or previous employers:Reference 1*NameProfessionEmailPhone Reference 1: Address* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Reference 2NameProfessionEmailPhone Reference 2: Address Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Acknowledgement and AgreementYes* I agree to the following statement: I certify that all statements given on this application are true and correct to the best of my knowledge. I agree that any false statements, misrepresentations or omissions of fact during the hiring process may be grounds for denial of employment or if hired before discovery; my employment may be subject to termination. I freely and voluntarily agree to submit to a drug test at any time as may be allowed by state or federal law as part of my application for employment and that any offer of employment is conditional upon passing said pre-employment testing. I also understand and agree that my employer reserves the right to require me to submit to an alcohol test and or medical examination to the extent permitted by law. I further understand that refusal to submit to said drug and or alcohol testing as are permitted by law, or the positive testing for prohibited drugs and or alcohol in accordance with standards established by either state or federal law, may result in disciplinary action, including immediate suspension or termination of employment. Further, I understand that you may be requesting information from various federal, state, or other agencies which maintain records concerning my past activities relating to my driving, credit, criminal, civil and other experiences. I understand and agree that if hired, I have the right to resign my employment at any time, with or without cause, and that my employment may be terminated with or without cause or notice. I understand that this acknowledgement supersedes any prior oral or written understanding. I understand that Cladding Systems Application may contact my previous employers, unless otherwise stated, and I authorize employers to disclose all records and other information pertinent to my employment and release them from liabilities that may result from such disclosure. I authorize, without reservation, any party or agency contacted by this employer to furnish the above mentioned information.Upload a résuméAccepted file types: pdf, doc, Max. file size: 2 MB.NameThis field is for validation purposes and should be left unchanged.
