Employment Application

                                                                                                Date: ___________________

Name:___________________________________                                   Soc. Sec. #:______________

Address:_________________________________                                   City:___________________

State:______ Zip:________ Phone:____________                                    Alternate:________________

Previous Address:___________________________________________________________________

Position(s) Desired:________________________________________________________

Are you interested in:                         Full-Time________                             Part-Time________

Have you or a relative ever worked for Clair Boring Painting & Services?                Yes____                No____

If yes, please provide dates and location:____________________________________________________

Are you legally able to be employed in the U.S.?           Yes____                No____

Are you 18 years of age or older?     Yes____   No____  If no, provide birth date:____________________

If under 18, do you have a work permit?          Yes____   No____ 

If no, provide school name:_______________________________________________________________

If hired, what is the earliest date that you would be available to start working?:______________________

What is your expected wage/salary?_________________________________________________________

Do you Smoke?______  

Do you have a valid PA driverís license? ______________  Have you had any traffic violations?_________   If yes, please explain__________________________________________________

Do you have reliable transportation to work?___________

What specific Days and/or hours are you available to work?

Sun______     Mon______                    Tues______     Wed______     Thurs______     Fri______     Sat______

Education (list high school, college, or technical schools)

Name:_____________________________________________              Field of Study:______________________

Address:___________________________________________  Graduate?:  Yes________   No_________

Last Grade or year completed:______________  Are you currently enrolled?: Yes______    No_________

 

Name:_____________________________________________              Field of Study:______________________

Address:___________________________________________  Graduate?:  Yes________   No_________

Last Grade or year completed:______________  Are you currently enrolled?: Yes______    No_________

 

Name:_____________________________________________              Field of Study:______________________

Address:___________________________________________  Graduate?:  Yes________   No_________

Last Grade or year completed:______________  Are you currently enrolled?: Yes______    No_________

 

Work Experience (list any Military or volunteer work)

Company:__________________________________________ Position Held:________________________

Address:___________________________________________  Phone:_____________________________

Dates of Employment:   From:________ To:________               Wage or Salary: $________ per _________

Supervisor:_______________________  Reason for Leaving:____________________________________

 

Company:__________________________________________ Position Held:________________________

Address:___________________________________________  Phone:_____________________________

Dates of Employment:   From:________ To:________               Wage or Salary: $________ per _________

Supervisor:_______________________  Reason for Leaving:____________________________________

 

Company:__________________________________________ Position Held:________________________

Address:___________________________________________  Phone:_____________________________

Dates of Employment:   From:________ To:________               Wage or Salary: $________ per _________

Supervisor:_______________________  Reason for Leaving:____________________________________

 

Company:__________________________________________ Position Held:________________________

Address:___________________________________________  Phone:_____________________________

Dates of Employment:   From:________ To:________               Wage or Salary: $________ per _________

Supervisor:_______________________  Reason for Leaving:____________________________________

Is there any reason or limitation which may prohibit you from doing the work for which you are considered?  Yes_____  No_____  If YES, please explain in detail:__________________

______________________________________________________________________________________

Have you ever been convicted of a crime?  Yes_____  No_____  If YES, please explain in full detail:

______________________________________________________________________________________

(Note:  A conviction will not necessarily bar you from employment.)

To the Applicant:  Please read the following and sign this application below before returning it to the Employer for consideration.  Please address any questions you may have about anything contained in this application to Clair Boring Painting & Services, Inc. before signing the application.

 

To the Employer:  I hereby certify that all of the information contained in this application is true, correct, and complete to the best of my knowledge.  I understand and agree that any deliberate falsification or omission of relevant information contained in this application is grounds for immediate dismissal, in accordance with the Company policy.

 

I hereby authorize all previous employers or educational institutions to provide you with any and all information concerning my previous employment, educational, or personal history.  I hereby release and hold harmless all parties from any liability or damage that may result from furnishing said information to you.

 

I hereby authorize you to contact all previous employers or educational institutions for the purpose of verifying information supplied on this job application, or for the purpose of obtaining more specific information about my employment, educational, or personal history.  I hereby release and hold harmless the Company from any liability or damage that may result from contacting said previous employers or educational institutions.

 

I hereby acknowledge that, if I become employed, I will be free to terminate my employment at any time for any reason, and that the Company retains the same rights.  No Company representative has the authority to make any other contrary agreement in this regard.

 

 

__________________________________ __________________________________ _________________

Print Name                                                         Signature                                                            Date

Clair Boring Painting & Services, Inc. is an Equal Opportunity Employer, and does not discriminate for purposes of employment or promotion on the basis of race, color, religion, sex, national origin, age, or physical handicap where prohibited by law.  It is our policy to comply fully with laws that prohibit illegal employment discrimination, and any information requested on this application will not be used for any purpose that is prohibited by law.

 

The application is considered active for 90 days.  For consideration after 90 days, you must reapply.  If hired, you must furnish your Social Security Card and one (1) of the following items within 72 hours of starting work: *Federal, State, or Local Government photo identification card *Photo driverís license *U.S. Military photo identification card *Birth Certificate *U.S. Passport *Stamped insurance form.

 

If you are a high school student, you must provide work permit upon starting employment.