Cirrus Construction - Employment Form

Employment Application

Personal Information

Name (Last, First, Ml)*

Street address*

City, State, Zip*

Home phone number*

Work phone number

Email Address*

Driver's license number/state/expiration*

Employment Desired

Position applied for

How did you hear about this position?

Date available for work

Desired hours (full time, part time, etc.)

Education

Name and Address of High School*

Total Years of Study

Diploma*

Name and Address of Undergraduate College

Course of Study

Total Years of Study

Degree

Name and Address of Graduate School

Course of Study

Total Years of Study

Degree

Other (Specify)

List any seminars, classes or other education not listed above which may help qualify you for this position

Employment History

List below all present and past employers over the past ten years, starting with your most recent employer. Account for all periods of unemployment. You must complete this section even if attaching a resume.

May we contact your current employer?*

Yes

No

Employer*

Start/End Dates*

Is this your your current employer?*

yes

no

Address*

City, State, Zip*

Phone number*

Supervisor(s)*

E-mail address of supervisor*

Job position(s)*

Starting/Ending Salary*

Essential job functions*

What value did you add to this company or its customers?*

Reason for leaving*

Employer*

Job position(s)*

Start/End Dates*

Starting/Ending Salary*

Address*

City, State, Zip*

Phone number*

Supervisor(s)*

E-mail address of supervisor*

Reason(s) for leaving*

What value did you add to this company or its customers?*

List any professional, trade, business or civic activities and offices held. You may exclude membership that would reveal gender, race, religion, national origin, ancestry, age, disability or any other protected status.

List any languages other than English that you can speak, read or write that could be of benefit to the position applied for:

Language

Fluent

Good

Fair

Language

Fluent

Good

Fair

Identify formal job training that relates to this position

Identify what skills or certification you possess related to this position

If you are hired, what value would you add to our company?

Describe what you believe are the most unique features of your work history

Have you ever been employed with this company before?*

Yes

No

If yes, when?

Do you have any friends or relatives employed by this company?*

Yes

No

If Yes, please provide their names and relationship to you

Are you currently employed?*

Yes

No

May we contact your employer?*

yes

No

NA

Are you currently on "lay off' status and subject to recall?*

Yes

No

If you are under 18 years of age, can you provide proof of your eligibility to work?*

Yes

No

NA

If hired, can you provide proof of U.S. citizenship or proof of your legal right to work in the U.S.?*

Yes

No

Are you able to perform all of the essential functions of the job for which you are applying with or without reasonable accommodation?*

Yes

No

If hired, are there any accommodations the company would need to provide so that you can perform all those essential functions and duties of the position being applied for?*

Yes

No

If Yes, please explain

If driving is a requirement of the position applied for, have you in the last 7 years been convicted of Driving Under the Influence "(DUI)"*

Yes

No

NA

If hired, do you have a reliable means of transportation to and from work?*

Yes

No

If hired, would you be able to travel or work overtime as needed?*

Yes

No

Have you ever been convicted of a felony or misdemeanor?*

Yes

No

If Yes, please explain

A criminal record does not constitute an automatic bar to employment and will be considered only as it substantially relates to the job in question

References

List below three persons not related to you who have knowledge of your work performance within the last 5 years

Name*

Occupation

Company name*

Address*

Telephone*

E-mail Address*

Relationship & years acquainted*

Name*

Occupation*

Company name*

Address*

E-mail Address*

Relationship & years acquainted*

Name*

Occupation*

Company name*

Address*

E-mail Address*

Relationship & years acquainted*

Additional space provided to expand on any points or questions asked previously in this application

Please read each statement closely and initial each acknowledging your understanding

Equal Employment Opportunity Statement*

This company is committed to the principles of equal employment opportunity and is committed to make employment decisions based on merit. We are committed to complying with all Federal, State and local laws providing for equal employment opportunities, as well as all laws related to terms and conditions of employment. The Company desires to maintain a work environment that is free of sexual harassment and discrimination due to race, religion, color, national origin, physical or mental disability, age or any other status protected by Federal, State or local laws. The Company will make reasonable efforts to accommodate those physical or mental limitations of an otherwise qualified employee unless undue hardship would result for the company.

Discrimination and Sexual Harassment Policy Statement*

This Company will not tolerate any form of unlawful discrimination, including sexual harassment. Any employee who engages in unlawful discrimination or sexual harassment will be subject to appropriate discipline, up to and including termination. Prohibited sexual harassment is defined as follows: Unwelcome sexual advances, requests for sexual favors and other verbal or physical conduct of a sexual nature constitutes sexual harassment when (1) submission to such conduct is made whether explicitly or implicitly a term or condition of an individual's employment; (2) Submission to or action of such conduct by an individual is used as the basis for employment decisions affecting such individuals; or (3) Such conduct has the purpose or effect of unreasonably interfering with an individual's work performance or creating an intimidating, hostile or offensive work environment.

Disclosure to Applicants Concerning Drug/Alcohol Testing*

If you are offered a position with the Company, you may be given a drug/alcohol test as a condition of employment. Your refusal to timely submit to a drug/alcohol test or your failure to pass such a test means you will not be employed by this company. Neither the collector of specimens nor the medical professional who reviews the test results will be a company employee. The test results will be kept confidential. The individual undergoing testing will not be directly observed while providing the specimen unless there are reasonable grounds to believe the individual may alter or substitute the specimen. Negative test results are required as a condition of employment.

Complete and Accurate information*

I hereby certify that I have not knowingly withheld any information that might adversely affect my chances for employment and that the answers given by me are true and correct to the best of my knowledge. I further certify that I have personally completed this application. I understand that any omission or misstatement of material fact on this application, or any other document used to secure employment, shall be grounds for rejection of this application or for immediate discharge if I am employed, regardless of the time elapsed before discovery.

At-Will Employment*

understand and agree that if I am employed, my employment will be "at-will", which means that the Company may terminate the employment relationship at any time, with or without cause and with or without notice. Likewise, the Company will respect my right to terminate my employment at any time, with or without cause and with or without notice. I further understand that any prior representation, whether expressed or implied to the contrary is hereby superceded and that no promise or representation contrary to the foregoing is binding on the Company unless made in writing and signed by the Company's president.

Testing Authorization*

If offered a position with the Company, I hereby agree to any legally permitted physical, psychological, skill, drug or medical test required by the Company as a condition of employment

Investigation Authorization*

I authorize investigation into all statements and references contained in this application. Said investigation may include credit, driving, criminal background, references and other background checks. By applying for this job, I also authorize post-hire investigation into my credit, driving and criminal background.

Company Obligation*

I understand and agree that the Company's acceptance of this job application does not mean that a position for which I am qualified is open (unless specifically posted) or that the company has agreed to hire me. I understand that the Company is under no obligation to hire me as the result of accepting this completed application.

I HAVE READ AND UNDERSTAND THE ABOVE POLICY STATEMENTS AND AGREE
TO BE BOUND BY THEM IF EMPLOYED BY THE COMPANY.

Initials*

Date*