Employment Application Application for Employment Required fields are marked with a '*' Date* MM slash DD slash YYYY Job Applied For* Type of employment sought*Full TimePart TimeTemporaryPERSONAL INFORMATIONName* 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 Phone*Email* Enter Email Confirm Email Are you 18 years old or older?*YesNo(If hired you may be required to submit proof of age.)If hired, can you provide proof that you are eligible to work in the U.S.?*YesNoHave you ever applied here before?*NoYesEnter the date you applied here before (if any)* Month Day Year Have you ever worked here before?NoYesEnter the date you worked here before (if any)* Month Day Year Enter details of any law violations (except minor traffic violations). If none, enter 'None'*(This does not automatically disqualify you from employment, since the nature of the offense, date, and the job for which you are applying will also be considered.)What class of valid driver's license do you have?*R (basic)CDL-ACDL-BCDL-CNoneGive details of any drivers license suspensions or revocations in the last 3 years. If none, enter 'None'*Attach Driving RecordAccepted file types: pdf, jpg, gif, png, Max. file size: 2 MB.List others names under which you have worked or attended school (if any.)First NameMiddle Name or InitialLast Name Click the '+' symbol to add more rows.)Are you presently employed?*YesNoHave you ever been fired or asked to resign from a job?*NoYesIf you answered 'yes' to the previous question, please explain.*EDUCATION AND TRAININGEducation*School Name and Address# of yearsDiploma/DegreeSubject On 3 separate lines, enter information about your High School/GED, College/University, and Vocation/Technical School. (Click the '+' symbol to add another line.)What skills or additional training do you have that are related to the job for which you are applying?What machines or equipment can you operate that are related to the job for which you are applying?EMPLOYMENT HISTORYPlease list names of employers in consecutive order with present or last employer first. Account for all periods of time including military service and any periods of unemployment. If self-employed, give firm name and supply business references. Most Recent Employer Employer Name Street Address City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Your position(s) with the employerJob Title and DutiesDates (mm/yy - mm/yy)Pay (starting - final)Reason for leaving Click the '+' symbol to add more rows.)Supervisor(s)NamePhone (Click the '+' symbol to add more rows.)Previous Employer Employer Name Street Address City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Your position(s) with the employerJob Title and DutiesDates (mm/yy - mm/yy)Pay (starting - final)Reason for leaving Click the '+' symbol to add more rows.)Supervisor(s)NamePhone (Click the '+' symbol to add more rows.)Previous Employer Employer Name Street Address City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Your position(s) with the employerJob Title and DutiesDates (mm/yy - mm/yy)Pay (starting - final)Reason for leaving Click the '+' symbol to add more rows.)Supervisor(s)NamePhone (Click the '+' symbol to add more rows.)REFERENCESGive 3 references, not relatives or former employers.NameAddressPhone Click the '+' symbol to add more rows.CERTIFY AND SIGNPlease read each statement carefully before signing.Read hiring practices* I have read and understand the DeFalco Hiring Policies and Procedures posted on this website regarding drug testing and work authorization. Accuracy of Information* I agree with the following statements: I certify that all information provided in this employment application is true and complete. I understand that any false information or omission may disqualify me from further consideration for employment and may result in dismissal if discovered at a later date. I understand that the employer may request an investigative consumer report from a consumer-reporting agency. This report may include information as to my character, reputation, personal characteristics and mode of living obtained from interviews with neighbors, friends, former employers, schools and others. I understand that I have a right to make a written request within a reasonable time for the disclosure and address of the consumer-reporting agency so that I may obtain a complete disclosure of the nature and scope of the investigation. I authorize the investigation of any and all statements contained in the application and also authorize any person, school, current employer (except as previously noted) past employers and organizations named in this application to provide relevant information and opinions that may be useful in making a hiring decision. I release such persons and organizations from any legal liability in making such statements. I understand that if I am extended an offer of employment, it will be conditioned upon my successfully passing a pre-employment physical and drug screening. I consent to the release of any and all medical information as may be deemed necessary to judge my capability to do the work for which I am applying and consent to all pre and post employment drug screening as a condition. I understand that this application or subsequent employment does not create a contract of employment nor guarantee employment for any period of time. If employed, I understand that I have been hired at the will of the employer and my employment may be terminated at any time, with or without cause and with or without notice. I give my consent to a health screen and an analysis of the results for the presence of drugs/alcohol. This is given to DeFalco Construction Company in conjunction with my application for employment. I understand that the examination and testing for drugs/alcohol will be done by an independent laboratory selected by DeFalco Construction Company and that the test results of the health screening will be given to DeFalco Construction Company for the purpose of evaluating my qualifications and fitness for employment. I understand that the results of the Health/drugs/alcohol screening may result in my disqualification from employment. I am giving this consent voluntarily, with the understanding that this consent is a necessary part of the processing of my job application with DeFalco Construction Company. I have read, understand and by my signature consent to these statements. Signature*Use your mouse (or your finger on a touch-screen device) to sign the form.PhoneThis field is for validation purposes and should be left unchanged.
